Enamel Opacities Research Articles

The efficacy of resin infiltrate on the treatment of white spot lesions and developmental opacities.

The aim of this study was to evaluate the changes in opacities by applying resin infiltrate to developmental enamel opacities and applying resin infiltrate or fluoride varnish to white spot lesions (WSLs). A total of 132 teeth with WSLs and developmental enamel opacities were included in the study. WSLs were treated with resin infiltrate (Group 1) and fluoride varnish (Group 2), and developmental enamel opacities were treated with only resin infiltrate (Group 3). Lesions were evaluated in accordance with International Caries Detection and Assessment System (ICDAS II) criteria and DIAGNOdent Pen scores before applying the material (T0), just after the application (T1), and after 1 month (T2) and 3 months (T3). A significant decrease in DIAGNOdent Pen scores was observed in all the groups and the most important decrease was seen in Group 2 (P < 0.05). A significant decrease in ICDAS II scores was observed in Groups 2 and 3 (T0-T1) and Group 1 (T1-T2) (P < 0.05). DIAGNOdent pen scores decreased and the lesion was partially masked after resin infiltrate was applied to treat developmental enamel opacities; the resin infiltrate application, however, was more successful than fluoride varnish on WSLs. Treating WSLs with resin infiltrate was a good option due to shorter term esthetic recovery and high patient satisfaction.

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.

Molar incisor hypomineralization: proportion and severity in primary public school children in Graz, Austria

ObjectiveThe aim of this study was to determine the proportion and severity of molar incisor hypomineralization (MIH) in primary school children in Graz (southeast of Austria).Materials and methodsIn 1111 children aged 6 to 12 years (mean age 9.0 ± 1.2), a wet examination of all teeth was performed by three trained examiners using a dental chair, optimal illumination, a dental mirror, and a dental explorer. All teeth with MIH lesions were registered so that different definitions of MIH were applicable. According to the European Academy of Pediatric Dentistry criteria that were considered valid at the time of the investigation, MIH was diagnosed when at least one first primary molar (FPM) was affected.ResultsMIH was present in 78 children (7.0%). In 64 children (5.8%), at least one molar and one incisor were affected (so-called M + IH). Additionally, in 9 children, only incisors were affected. In 7 affected children, teeth other than FPMs and incisors had MIH lesions. Almost an equal number of males (38) and females (40) were affected. The upper and lower molars were equally affected. The upper incisors were more frequently affected than the lower ones. Demarcated enamel opacities were the predominant types of defects.ConclusionThe proportion of MIH was 7.0% in Graz, which is similar to other comparable trials.Clinical relevanceThis study has proven that MIH is an existing dental problem in Graz.

Prevalence, characteristics and severity of hypomineralization of the first permanent molars and incisors in children from the northern part of Kosovo and Metohija

Introduction/Objective. Molar-incisor hypomnineralization (MIH) is relatively common developmental anomaly characterized by hypomineralized enamel defects in the first permanent molars and incisors. The aim of this study was to determine the prevalence of hypomineralization of the first permanent molars and incisors in children aged eight and 10 years who live in the northern part of Kosovo and Metohija. Methods. The study included 712 respondents, 289 of whom aged eight (40.6%) and 423 of whom aged 10 years (59.4%). Criteria according to Weerheijm were used for diagnosis of hypomineralization and the severity of changes was determined. Results. The frequency of hypomineralized changes in the first permanent molars and incisors of the examined children in this area was 12.2%. It was lower in children aged eight years (10.7%) compared to those aged 10 (13.2%). Demarcated enamel opacity was more common in younger children, whereas both atypical restoration and tooth extraction due to hypomineralization were more common in older children. Mild form is more common in children aged eight years, whereas both severe form and severe form with extracted teeth are more common in children aged 10 years. The results indicate that the first permanent molars were most commonly affected by MIH changes. Conclusion. The percentage of the respondents with MIH changes in the northern part of Kosovo and Metohija, which is 12.2%, is not negligible and points to the necessity of early diagnosis in order to prevent and reduce the complications of the condition by timely prevention and treatment.

Microabrasion and composite resin for re-establishing smile esthetics: a case report

Dental hypomineralization such as dental fluorosis has increased in recent times leading to unaesthetic appearance of teeth. There are different treatment possibilities to improve the aesthetic appearance of hypomineralized enamel described in dental literature. The enamel microabrasion has been a feasible alternative, since it is a fast, safe, conservative, and easy to perform, which promotes good esthetic results. Moreover, this technique is a conservative method that improves the appearance of the teeth by restoring bright and superficial smoothness, without causing significant structural loss. The association of different techniques, such as direct composite resin, can provide good esthetic outcomes, but the etiology, intensity, and depth of stain should be considered to minimize dental structure loss. Objective: To describe an easy technique for managing dental fluorosis using enamel microabrasion in association with direct composite resin. Case report: A mixture of hydrochloric acid and silicon carbide was applied according the manufacturer’s instructions. Subsequently, a direct composite resin was applied over the areas where the opacities were more evident. This conservative approach may be considered an interesting alternative treatment to remove fluorosis staining and to improve aesthetic appearance. Conclusion: enamel microabrasion combined with direct composite resin is a conservative and safe alternative method to treat enamel opacities from dental fluorosis. Therefore, this management provides satisfactory aesthetic results for the patient’s smile.

Management of opacities in children and adolescents

Enamel opacities can appear as white, cream, yellow or brown patches. They can result from developmental or acquired conditions. The diagnosis, severity of the opacity and patient's desire for treatment guide the clinician when choosing the correct management option. Microabrasion is indicated for surface opacities, whereas bleaching can treat opacities deep within the tooth. When these techniques have failed to achieve the desired result, camouflaging the opacity with composite resin may be useful. Novel techniques, such as infiltrating or sealing the opacity, can alter enamel's refractive index, offering further treatment choices. CPD/Clinical Relevance: There are many conservative treatments available which can improve the appearance of enamel opacities.

Prevalence of molar incisor hypomineralization (MIH) in Singaporean children

There is a lack of data on molar incisor hypomineralization (MIH) in Asia, but this is not an indication that MIH is rare in the Asian population. Early identification of MIH is important as affected teeth frequently display post-eruptive enamel loss which would result in rapid caries progression. This objective of this study was to assess the prevalence of MIH in Singaporean children. Patients were recruited from 30 schools across Singapore. All children were examined by a single dentist, and the judgement criteria used were based on the 2003 European Academy of Paediatric Dentistry criteria. A total of 1083 children; average age of 7.7 ± 0.3 years were examined. One hundred and thirty-five children (12.5%) had MIH. A significantly higher proportion of children of the Malay ethnicity had MIH, compared to Chinese children (P = 0.02). Post-eruptive enamel breakdown and the presence of atypical restorations were correlated with increasing number of MIH teeth/child (Rho= 0.599, P < 0.001) and the cumulative enamel opacity colour score (Rho = 0.601, P < 0.001). Our findings suggest the role of ethnicity in MIH occurrence and that MIH severity may be influenced by the number of MIH teeth/child and the cumulative enamel opacity colour score.

Esthetic Management of Developmental Enamel Opacities in Young Permanent Maxillary Incisors with Two Microabrasion Techniques—A Split Mouth Study

This study evaluated the effectiveness of two microabrasion materials for the removal of developmental enamel opacities in young permanent maxillary incisors. Using a split-mouth study design, 37% phosphoric acid and 18% hydrochloric acid were used for removal of visually unesthetic developmental enamel opacities of young permanent maxillary anterior teeth from 25 subjects (11-13 years old) by two microabrasion techniques for 10 and 5 seconds respectively. This procedure was repeated four to six times during each clinical appointment. The subjects were evaluated about their satisfaction with the treatment. Two blinded evaluators appraised both sides of the mouth using visual analog scale. The records were analyzed using Wilcoxon test. The majority of the subjects (approximately 97%) reported satisfaction at the end of the treatment (p = 0.001**). Statistical significant reduction in enamel opacities was observed by evaluators immediately after microabrasion technique in group 1 (81.75%) and in group 2 (81.4%) (p < 0.002). Reduction was increased to 97.2% in group 1 and 96.7% in group 2 after 1 month. Both microabrasion techniques showed comparative highly significant successful results in esthetic management of enamel opacities clinically and in terms of subject's satisfaction. Developmental enamel defects like diffuse opacities due to high-fluoride content in water and demarcated opacities associated with positive dental history and are commonly seen in young permanent maxillary incisors of both boys and girls in their developing years. They are aware of unesthetic appearance of these newly erupted permanent anterior teeth and become highly motivated when informed about minimally invasive, patient friendly, cost-effective, and safe treatment like microabrasion for esthetic improvement. Both noninvasive microabrasion techniques using 37% phosphoric acid (group 1) and 18% hydrochloric acid (group 2) show comparatively high success results in treating enamel defects successfully to the subject's satisfaction along with their parents.

Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: A randomized clinical trial

ObjectivesThis parallel randomized clinical trial evaluated the efficacy of two treatments for removing fluorosis stains. MethodsSeventy individuals living in an area endemic for fluorosis, with at least four maxillary anterior teeth presenting fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n=35): GI – enamel microabrasion or GII – microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice and, at-home tooth bleaching was performed with 10% carbamide peroxide. Areas of enamel opacities were recorded by digital camera at baseline and 1-month (1M) after treatment. Two blinded examiners evaluated the reduction in the area (mm2) of opacity using software. Two visual analogue scales were used: one for recording tooth sensitivity and/or gingival irritation ranging from 1 (none) to 5 (severe) and the other to evaluate participant satisfaction with the treatment used ranging from 1 (no improvement) to 7 (exceptional improvement). Results1M after treatment, both groups showed a significant reduction in the area of enamel opacity (p=0.0001) and there was no difference between groups (p=0.1). Most of the participants from both treatment groups reported no or mild tooth sensitivity and gingival irritation (p>0.05). Participants reported that they were happy with the improvement in dental appearance, however, individuals from GII reported that they were happier than those from GI (p=0.004). ConclusionsBoth treatment protocols were effective in reducing fluoride stains, however, when home bleaching was associated to enamel microabrasion, patients reported a major satisfaction with dental appearance.

Enamel hypoplasia and its correlation with dental caries in 12 and 15 years old school children in Shimla, India

Aim: The aim was to assess the prevalence of enamel hypoplasia and its correlation with dental caries in 12 and 15 years old school children in Shimla city, Himachal Pradesh, India. Materials and Methods: This was a cross-sectional study conducted on a sample of 1011 school children aged ranging between 12 and 15 years old in Shimla city, Himachal Pradesh, India. A modified developmental defects of enamel index was used to classify the enamel defects. The statistical tests used was Chi-square tests. P < 0.05 was considered to be statistically significant. Results: The prevalence of enamel opacities was 18.2%. At 12 years of age, the prevalence was 17.9%, whereas at 15 years it was 18.6%. The tooth prevalence of enamel opacities of the entire sample was 11.8%. At 12 years tooth prevalence was 10.9% and at 15 years it was 12.7%. There was a significantly higher prevalence of Enamel hypoplasia among males at both the age groups. The diffuse type of enamel opacity was the most commonly seen at both the age groups. A significant association was found between caries and enamel opacities (P < 0.01). The occurrence of enamel opacities was statistically higher in children with the youngest mothers. Conclusions: The prevalence of enamel defects in this study is low when compared to National prevalence (22.3% at 12 years and 23.2% at 15 years). This study revealed a significant association between enamel defects and dental caries.

Developmental enamel defects in children born preterm: a systematic review

The purpose of this review was to evaluate the association between developmental enamel defects and children born preterm. An identical search was performed in PubMed and Embase and was limited to human studies and studies written in English, German, Danish, Swedish, or Norwegian. Reviews, case studies, and case series were excluded. A total of 283 articles were identified. Twenty-three publications, of which 19 were follow-up studies, two were case-control studies, and two were cross-sectional surveys, were enrolled in the review. The majority of the studies (n=17) dealt with enamel hypoplasia of the primary teeth. Thirteen studies reported an association between preterm birth and enamel hypoplasia, and, in addition, few studies reported an increased risk of enamel opacities in the primary teeth, in children with a birth weight <1500g. Seven studies dealt with enamel disturbances of the permanent teeth, four of which suggested an increased risk of enamel opacities. This systematic review suggests an increased risk of enamel hypoplasia in primary teeth of children born preterm and enamel opacities in very-low birth-weight children. A larger number of well-designed studies are, however, needed in order to increase the validity of the studies.

Mineral content in teeth with Deciduous Molar Hypomineralisation (DMH)

ObjectivesWe report the mineral (hydroxyapatite) density of sound and opaque areas in DMH molars with sound parts of (carious) deciduous teeth serving as controls. MethodsTwenty-nine extracted second primary molars obtained from 15 children were studied. Thirteen of these molars were DMH molars with yellow opacities, seven were DMH molars with white opacities, three DMH molars with brown opacities and eleven were molars without DMH. Prior to microCT scanning, the teeth were mounted in impression material (Impregum®) and stored in water with a thymol crystal. Spot analysis and line scans were performed in areas with opacities and in sound areas.An ANOVA test and t-tests were used to test if there were significant differences between the groups. ResultsThe average densities of the hydroxyapatite in yellow and brown opacities (1368mg HA/cm2 and 1407mg HA/cm2, respectively) were significantly lower than in clinically unaffected enamel (1747mg HA/cm2) of DMH molars or of sound molars (1758mg HA/cm2). The mineral density in white opacities (1737mg HA/cm2) was not different from that in the enamel of sound molars. The mineral density values in yellow and brown enamel opacities were in between those of dentine (1018mg HA/cm2) and enamel. ConclusionsDMH molars with yellow or brown opacities had a 20–22% lower mineral density in the hypomineralised enamel compared with sound molars. White opacities do not show a lower mineral content. The reduction in enamel mineral content in DMH molars stressed the need for a preventive approach in DMH.

Bacterial colonization, enamel defects and dental caries in 4-6-year-old mono- and dizygotic twins

Knowledge of the genetic and environmental influences in caries aetiology has relevance for preventive dentistry. This classical twin study compared concordance of mutans streptococci (MS) and lactobacilli (LB) colonization, enamel defects, and caries in a cohort of 4-6-year-old mono- (MZ) and dizygotic (DZ) twin pairs. The twins were examined for prevalence and concordance of enamel opacities and hypoplasia, oral counts of MS and LB, and dental caries. Bacterial counts were assessed using a commercial microbiological kit. Thirty-four MZ and 50 DZ twins (mean gestational age 35.0 ± 2.4 weeks, and birthweight 2.4 ± 0.6 kg) were examined. There were no statistically significant differences between MZ and DZ twins in the prevalence of MS, LB, and enamel hypoplasia. Concordance rates for MS and LB presence and prevalence of enamel defects within MZ and DZ twin pairs were not significantly different. There were more children with caries in DZ compared with MZ twins (18% vs 3%, P = 0.0029), most likely due to increased daily frequency of sugar consumption and less toothbrushing. Concordance data from MZ and DZ twins did not demonstrate any statistically significant difference in susceptibility for enamel defects and colonization of MS and LB.

Developmental enamel defects in the primary dentition: aetiology and clinical management

Developmental enamel defects, presenting as enamel hypoplasia or opacities are caused by damage or disruption to the developing enamel organ as a result of inherited and acquired systemic conditions. The high prevalence of these defects in the primary dentition demonstrates the vulnerability of the teeth to changes in the pre- and postnatal environment. The presence of enamel hypoplasia increases the risk of primary teeth to early childhood caries and tooth wear as the defective enamel is thinner, more plaque retentive and less resistant to dissolution in acid compared to normal enamel. The purpose of this paper was to critically review the aetiology and clinical complications of developmental enamel defects in the primary dentition and propose recommendations for the clinical management of affected teeth.

Developmental Enamel Defects in Children Prenatally Exposed to Anti-Epileptic Drugs

ObjectiveSome anti-epileptic drugs (AED) have well-known teratogenic effects. The aim of the present study was to elucidate the effect of prenatal exposure to AED and the risk of enamel defects in the primary and permanent dentition.MethodsA total of 38 exposed and 129 non-exposed children, 6–10 years of age, were recruited from the Aarhus Birth Cohort and the Department of Neurology, Viborg Regional Hospital, Denmark. Medication during pregnancy was confirmed by the Danish Prescription Database. All children had their teeth examined and outcomes in terms of enamel opacities and enamel hypoplasia were recorded.ResultsChildren prenatally exposed to AED have an increased prevalence of enamel hypoplasia (11% vs. 4%, odds ratio (OR) = 3.6 [95% confidence interval (CI): 0.9 to 15.4]), diffuse opacities (18% vs. 7%, OR = 3.0; [95% CI: 1.0 to 8.7, p<0.05]), and numerous (>3) white opacities (18% vs. 10%, OR = 2.2; [95% CI: 0.8 to 6.1]) in the primary dentition. In the permanent dentition, an increased risk of numerous (>3) white opacities (34% vs. 12%, OR = 3.3; [95% CI: 1.3 to 8.4]) was found.ConclusionsThe present study shows that children prenatally exposed to AED have an increased risk of developing numerous teeth with white opacities in their primary and permanent dentition. In addition, they also have an increased risk of developing diffuse opacities and enamel hypoplasia in their primary teeth.

Surface-Specific Efficacy of Fluoride Varnish in Caries Prevention in the Primary Dentition: Results of a Community Randomized Clinical Trial

Objectives: Fluoride varnish (FV) is efficacious in caries prevention although its effects among different tooth surfaces are poorly understood. This study sought to determine the extent to which caries-preventive effects of a community intervention that included FV application among preschool-aged children varied according to primary tooth anatomy and baseline tooth pathology. Methods: Secondary analysis was undertaken of data from a community-randomized controlled trial among 543 3- to 5-year-old Aboriginal children in 30 Northern Territory Australian communities. Children in intervention communities received community health promotion and FV application once every 6 months. Net caries (d₃mfs) risk and 95% confidence limits (CL) were estimated for the control and intervention arms, and stratified according to tooth anatomy/location and baseline pathology (sound, enamel opacity, hypoplastic defect or precavitated carious lesion). The intervention’s efficacy was quantified using generalized estimating equation modeling accounting for study design and clustering. The assumption of efficacy homogeneity was tested using a Wald χ² test with a p < 0.2 criterion and post hoc pairwise comparisons. Results: The intervention resulted in a 25% reduction (relative risk, RR = 0.75; 95% CL = 0.71, 0.80) in the 2-year surface-level caries risk. There was substantial heterogeneity in FV efficacy by baseline surface pathology: RRs were 0.73 for sound, 0.77 for opaque, 0.90 for precavitated, and 0.92 for hypoplastic surfaces. Among sound surfaces, maxillary anterior facials received significantly more benefit (RR = 0.62) compared to pits and fissures (RR = 0.78). Conclusion: The intervention had greatest efficacy on surfaces that were sound at baseline. Among those sound surfaces, maxillary anterior facials received most caries-preventive benefit.

Investigation of the value of a photographic tool to measure self-perception of enamel opacities

BackgroundThe standard measurement of oral conditions that are mainly of cosmetic concern can be carried out by a trained clinical professional, or they can be assessed and reported by the individuals who may have the condition or be aware of others who have it. Enamel opacities of anterior teeth are examples of such a condition. At a public health level the interest is only about opacities that are of aesthetic concern, so the need for an index that records opacities that the public perceive to be a problem is clear. Measurement methods carried out by highly trained professionals, using unnatural conditions are not indicated at this level. This study reports on the testing of a novel epidemiological tool that aims to report on the prevalence and impact of self-perceived enamel opacities in a population of young adolescents.MethodsA dental health survey was carried out using a random sample of 12-year-old school pupils during 2008/09 by Primary Care Organisations (PCOs) in England. This included the use of a novel self-perception tool which aimed to measure individual’s self-perception of the presence and impact of enamel opacities to produce population measures. This tool comprised questions asking about the presence of white marks on their teeth and whether these marks bothered the volunteers and a sheet of grouped photographs of anterior teeth showing opacities ranging from TF 0, TF 1–2 to TF 2–3. Volunteers were asked which of the groups of photographs looked more like their own teeth. Examining teams from a convenience sample of 3 PCOs from this survey agreed to undertake additional measurements to assess the value of the self-perception tool. Volunteer pupils were asked the questions on a second occasion, some time after the first and clinical examiners recorded their assessments of the most closely matching set of photographs of the volunteers on two occasions.ResultsThe tool was feasible to use, with 74% of pupils making a response to the first question about the presence of white marks on front teeth, 94% to the second (do these marks bother you?) and 79% to the third about which set of images most closely matched the volunteer’s own, with regard to white marks. Responses to these sequential questions showed coherence with pupils who perceived themselves as having white marks on their teeth being more likely to select images that showed teeth with opacities to match with their appearance. Pupils who reported themselves concerned about their white marks were the most likely to select images with the most severe opacities. Repeatability was good among pupils (Kappa = 0.65) and very good among examiners (Kappa = 0.87). Agreement levels between pupil’s and examiner’s choice of images was poor as examiners were less likely than pupils to select images that showed more severe levels of mottling.ConclusionsWith regard to feasibility, coherence and repeatability the standardised epidemiological tool under scrutiny, with operator training, appears to be a suitable method for measuring the prevalence and impact of self-perceived enamel opacities in a population of young adolescents.

Dental anomalies in Richieri-Costa-Pereira syndrome

The objective of this study was to investigate the prevalence of dental anomalies in individuals with Richieri-Costa-Pereira syndrome. A total of 13 individuals with Richieri-Costa-Pereira syndrome who were older than 8 years with at least 1 available panoramic radiograph were assessed. Dental anomalies were evaluated clinically and radiographically and classified as hyperplastic, hypoplastic, or heterotopic and as alterations of shape, number, position, and structure. Enamel alterations were classified by the DDE index. All individuals exhibited anomalies, with predominance of hypoplastic disorders, mainly agenesis of mandibular incisors and second premolars and demarcated creamy-white enamel opacities primarily affecting the maxillary premolars. Individuals with Richieri-Costa Pereira syndrome exhibit high prevalence of tooth agenesis, especially mandibular incisors and premolars, as well as high frequency of enamel opacities. These findings are compatible with the mandibular cleft observed in all individuals and also reflect the hypoplastic characteristic of the syndrome.

Enamel defects in permanent incisors after trauma to primary predecessors: inter‐observer agreement based on photographs

Trauma to primary teeth may cause mineralization disturbances in the permanent successors. To study the distribution and type of enamel defects in permanent incisors after trauma to primary teeth and to examine inter-observer agreement when registrations were based on photographs. Of 266 children who suffered an oral injury to primary teeth in one county of Norway in 2003, 193 were included in a follow-up study to record enamel defects in the permanent successors 7 years later (age, 8-15 years). Clinical examination and intraoral photographs were undertaken by the principal investigator. The photographs were evaluated twice for enamel defects by three paediatric dentists. Evaluation 1: age at the time of injury, traumatized teeth and diagnoses were kept unknown to the examiners. Evaluation 2: age and trauma diagnoses were known to the examiners. Inter-observer agreement was calculated using Cohen's kappa and chi-square test. Of 338 successor teeth, 42% exhibited enamel defects. In neighbouring teeth (339) with non-injured predecessors, 30% were registered with defects. The most common enamel disturbance in successors was demarcated opacities, recorded in 18% of the teeth. Enamel defects owing to a previous trauma were registered in 37% of the children in Evaluation 1, kappa 0.88-0.93 and in 21% in Evaluation 2, kappa 0.63-0.84. The examiners disagreed on a higher proportion of the children when all information on the injury was available (P < 0.001). Demarcated enamel opacities were the most common defects in permanent successors. Although the inter-examiner agreement was good, the results indicated that recordings of enamel disturbances following trauma is associated with uncertainty.

Effect of protein energy malnutrition (PEM) on oral health status of children aged 6 years old in Sammawa city

Background: It has been realized that good nutrition is interdependent with good health, and the protein is the most important nutrient because it regulates the key process within the body, so if any deficiencies in protein occur this will lead to protein-energy malnutrition which is evaluated by using anthropometric measurements(height and weight). When PEM begins it affects adversely various aspects of growth and increase the severity of oral problems later. It has been reported that dental caries and enamel defect occur in malnourished children more than well nourished. The aim of this study was to investigate the nutritional status of children by physical examination and its effect on dental caries and enamel anomalies in relation to gender. Materials and methods: This study was conducted among urban primary school children aged 6 years in sammawa city which lies 300 Km south of Baghdad, were clinically evaluated to determine the prevalence of dental caries and enamel anomalies in relation to protein energy malnutrition. The sample size composed of 300 children distributed in primary schools which were randomly selected from different areas in sammawa city. The samples were examined physically by anthropometric measurements (weight and height) and orally for dental caries and enamel defects. Results: The malnourished children with mild grade was the most prevalent grade in this study, males showed malnutrition more than females within the same age group, dmfs and DMFS according to nutritional status indicators were higher among malnourished children than well nourished group, the enamel opacities was higher in females than in males regarding gender differences and according to nutritional status indicators was higher among well nourished children than malnourished group in both primary and permanent dentition. Conclusion: The prevalence of malnutrition was higher in boys than in girls, also the prevalence of dental caries was higher in malnourished children when compared with well nourished children, while enamel opacities was present only in well nourished children when compared with malnourished group, it was absent in malnourished children.