Extent Of Enamel Defects Research Articles

Maxillary incisor enamel defects in individuals born with cleft lip/palate.

Cleft lip with or without cleft palate (CLP) is considered the most frequent congenital malformations of the head and neck, with cleft individuals exhibiting more chances of presenting abnormalities such as developmental defects of enamel (DDE). Matrix metallopeptidase 2 (MMP2) is a membrane-bound protein with collagen-degrading ability and has important roles in tooth formation and mineralization. The aim of this study was to evaluate the frequency, location, severity and extent of DDE found in the maxillary incisors for groups of individuals born with CLP, as well as understanding their relationship with the cleft side. Besides, this study addresses the hypothesis that DDE can be influenced by variation in the MMP2 genes (rs9923304). Individual samples, clinical history, intraoral photographs and panoramic radiographs were obtained from 233 patients under treatment at the Cleft Lip and Palate Service of the University Hospital Lauro Wanderley at the Federal University of Paraíba. Digital images were examined by the same evaluator using the Classification of Defects According to the Modified DDE Index, and then loaded into the Image Tool software, where two measurements were made: total area of the buccal surface (SA) and the area of the DDE (DA), obtaining the percentage of the surface area affected (%SAD) (ICC = 0.99). Genomic DNA was extracted from saliva samples from 124 participants. Genotyping was carried out using TaqMan chemistry for one marker in MMP2 (rs9923304). Statistical analyses were performed by The Jamovi Project software. The Shapiro-Wilk test was applied, followed by the Student's t-test and the Mann-Whitney test. Chi-square and Fisher's exact tests, and odds ratio (OR) with 95% confidence interval (CI) calculations were used to determine Hardy-Weinberg equilibrium and statistically significant differences with an alpha of 0.05. No significant differences in the prevalence and extent of enamel defects were found between male and female individuals born with CLP (p = 0.058256). The frequency of individuals presenting teeth with DDE, in relation to the cleft and non-cleft side, was statistically different (p <0.001; OR = 7.15, CI: 4.674> 7.151> 10.942). However, the averages of %SAD were similar (p = 0.18). The highest means of the %SAD were found in individuals with bilateral cleft lip with or without cleft palate (BCLP) when compared to individuals with unilateral cleft lip with or without cleft palate (UCLP), for the teeth inside (IA) and outside the cleft area (OA) (p <0.001). Regardless of the cleft side, individuals with BCLP were 7.85 times more likely to have more than one third of the tooth surface affected, showing more frequently defects in the three thirds (OA: p <0.001) (IA: p = 0.03), as well as a higher frequency of more than one type of defect (OA: p = 0.000358) (IA: p = 0.008016), whereas in UCLP, defects were isolated and restricted to only one third, more frequently, the incisal third (OA: p = 0.009) (IA: p = 0.001), with greater frequency of milder defects, such as demarcated (p = 0.02) and diffuse (p = 0.008) opacities. A higher frequency of the T allele, less common, was observed in the group of CLP individuals who had all the affected teeth or at least two teeth with %SAD greater than 20% (p = 0.019843). Our results suggest that MMP2 may have a role in the cases that presented DDE and genotyping rs9923304 could serve as the basis for a genomic approach to define risks for individuals born with CLP. Frequency and severity of DDE is strongly related to the CLP phenotype, since the highest values were found for BCLP. However, the extent of the DDE is independent of its relationship with the side of the cleft.

Dental enamel defects predict adolescent health indicators: A cohort study among the Tsimane' of Bolivia.

Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs). Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.

Association of Pre- Peri- and Postnatal Factors with Developmental Defects of Enamel in Schoolchildren.

This study estimated the prevalence, extent, buccal distribution and associated factors involving enamel defects in Brazilian schoolchildren. A cross-sectional study using a multistage cluster random sample of 1,206 8-12-year-old Brazilian schoolchildren was carried out in Pelotas, Brazil. The prevalence of enamel defects in the permanent dentition was determined using the modified Developmental Defects of Enamel index (DDE). Sociodemographic and health data were collected from their mothers using a semi-structured questionnaire. Data were analyzed using Poisson regression modelling for DDE prevalence and negative binomial regression modelling for the extent of DDE. The prevalence of any enamel defects was 64.0% (95% Confidence Interval: 61.4, 67.0); the main types were diffuse opacities (35.0%), demarcated opacities (29.5%) and hypoplasia (3.7%). In general, older children had a lower prevalence and extent of enamel defects than their counterparts (p<0.001). There were no other significant associations. Enamel defects are common, especially among younger children, but the role of pre-, peri- and postnatal exposures remains unclear.

Prevalence and extent of enamel defects in the permanent teeth of 8‐year‐old Nigerian children

Enamel formation is a vulnerable developmental process, susceptible to environmental influences such as excessive systemic fluoride (F) exposure and infant/childhood disease. This study determined prevalence and extent of developmental enamel defects (DDE) and dental fluorosis in 8-year-old Nigerians and explored associations with key predictors. A sample of 322 healthy 8-year-olds (155 males, 167 females) from primary schools in lower and higher water F areas of (i) rural and (ii) urban parts of Oyo State in south-west Nigeria (n = 4 areas) (in which the mean (SD) F concentration of community water supplies ranged from 0.07 (0.02) to 2.13 (0.64) mg F/L) were dentally examined using modified DDE (mDDE) and Thylstrup and Fejerskov (TF) indices. Drinking waters, cooking waters and toothpaste samples were analysed for F concentration using a F ion-selective electrode (F-ISE). Information on infant/childhood diseases, infant feeding and tooth cleaning practices was obtained from parents/legal guardians. Data were analysed using ANOVA, chi-square tests, Spearman correlation and binary logistic regression as appropriate. Mean (SD) F concentration of actual drinking and actual cooking waters consumed by participants was 0.25 (0.20) and 0.24 (0.14) mg F/L respectively in the urban higher F area; 1.11 (1.00) and 1.16 (1.02) mg F/L, respectively in the rural higher F area (P < .05). Overall, mouth prevalence of DDE in the permanent dentition was 61.2% with a mean (SD) of 2.4 (2.2) index teeth affected. Dental fluorosis mouth prevalence was 29.8% with a mean of 2.1 (3.7) teeth affected. Prevalence and extent of DDE and dental fluorosis were greater in higher F than lower water F areas (P < .001). A weak positive correlation was seen between extent of dental fluorosis and drinking water F concentration (ρ = 0.28). The absence of infant/childhood disease was associated with a lower risk of DDE being present (P = .001), with an odds ratio of 0.43 (95% CI = 0.26, 0.71). Gender was a statistically significant (P = .014) predictor for dental fluorosis with females having a higher risk OR 1.94 (95% CI = 1.14, 3.28) of dental fluorosis than males. In these Nigerian 8-year-olds (n = 322), mouth prevalence of DDE was 61.2% (mean (SD) teeth affected = 2.4 (2.2)), and a key positive predictor was a history of infant/childhood disease. With 29.8% of these children exhibiting dental fluorosis (mean (SD) teeth affected = 2.1(3.7)), drinking water F concentration was identified as a positive predictor, along with gender, with females more at risk of dental fluorosis than males.

Risk factors in the occurrence of enamel defects of the first permanent molars among schoolchildren in Western Australia

The prevalence of enamel defects in the first permanent molars among children in Western Australia is higher than that reported for some European countries. The cause(s) of the defects, both white diffuse opacities and demarcated opacities, with or without hypoplasia, continue to be investigated. A recent review identified childhood illnesses and exposure to environmental toxins as putative causal factors for the occurrence of demarcated opacities (usually in association with hypoplasia). Diffuse opacities have been reported to be associated with exposure to the antibiotic amoxicillin, adjusted for otitis media and fluoride. The aim of this study was to examine the possible risk factors for enamel defects in the first permanent molars among children in Western Australia. Children attending pre-primary schools (1999-2000 year of birth) in metropolitan Perth, Western Australia, were invited to participate in the study. In 2005, before the child's first permanent molars had erupted, parents completed a questionnaire about the mother's health during pregnancy, and their child's health for the first 3 years. The first permanent molars were classified for type and extent of enamel defects using the modified Developmental Defects of Enamel (DDE) index. Caries experience and the presence of enamel defects on the deciduous molars and canines were also recorded using the WHO criteria. Bivariate, multinomial logistic and logistic regression analyses were used to test the factors for their influence on the occurrence of the enamel defects. Five hundred and fifty children were examined for the occurrence of enamel defects on the first permanent molars. Multinomial logistic regression indicated that neonatal health conditions, prematurity (OR 2.75) and other health conditions (OR 2.40) were significant risk factors for the occurrence of diffuse enamel defects. Infection during the neonatal period was a strong risk factor for the occurrence of demarcated enamel defects (OR 6.88). Increased deciduous tooth caries experience increased the risk of demarcated enamel defects by 10% (OR 1.10) and living further from a heavy industrial area increased the risk of diffuse enamel defects nearly twofold (OR 1.93). Neonatal health factors were found to be important risk factors for the occurrence of enamel defects in first permanent molars. The effects of residential location and the association between deciduous tooth caries experience and enamel defects require further investigations.

Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia

The prevalence of enamel defects in the first permanent molars among children has been reported to be high and may be on the increase, particularly in the European countries. Little information is available on the prevalence of enamel defects in the first permanent molars among children in Australia. The aim of this study was to describe the prevalence of enamel defects in the first permanent molars among school children in Western Australia. Informed consent was obtained from parents of children attending pre-primary schools within an administrative area of the School Dental Service of Western Australia in metropolitan Perth to participate in the study in 2005. Parents completed a questionnaire about the mother's health status during pregnancy, and their child's health status for the first three years. Participating children were examined during 2006 and 2007 by one examiner. Teeth were classified on the type and extent of enamel defects using the modified DDE index, and deciduous tooth caries experience of molars and canines was recorded using the WHO criteria. Parents of 634 children out of the eligible 1135 (56 per cent participation) completed the questionnaire. Five hundred and eleven children with at least one erupted first permanent molar were examined (mean age 7.1 years, SD 0.5). Of the first permanent molars, 42 per cent upper right; 37 per cent upper left; 47 per cent lower left; and 45 per cent lower right were without enamel defects. White diffuse opacities were the predominant enamel defects found with 46 per cent upper right; 47 per cent upper left; 40 per cent lower left and 41 per cent lower right molars affected. Demarcated opacities alone or in association with other defects affected 11 per cent upper right; 14 per cent upper left; 10 per cent lower left and 9 per cent lower right molars. At the individual level, 71 per cent had permanent molars with enamel defects; 47 per cent with white diffuse opacities and 22 per cent with demarcated opacities. Prevalence of enamel defects among this school population is high. Majority of defects were white diffuse opacities and the prevalence of demarcated opacities is at the high end of that reported for some European countries. Possible risk factors for enamel defects remains to be tested.

Near-infrared imaging of developmental defects in dental enamel

Polarization-sensitive optical coherence tomography (PS-OCT) and near-infrared (NIR) imaging are promising new technologies under development for monitoring early carious lesions. Fluorosis is a growing problem in the United States, and the more prevalent mild fluorosis can be visually mistaken for early enamel demineralization. Unfortunately, there is little quantitative information available regarding the differences in optical properties of sound enamel, enamel developmental defects, and caries. Thirty extracted human teeth with various degrees of suspected fluorosis were imaged using PS-OCT and NIR. An InGaAs camera and a NIR diode laser were used to measure the optical attenuation through transverse tooth sections (approximately 200 microm). A digital microradiography system was used to quantify the enamel defect severity by measurement of the relative mineral loss for comparison with optical scattering measurements. Developmental defects were clearly visible in the polarization-resolved OCT images, demonstrating that PS-OCT can be used to nondestructively measure the depth and possible severity of the defects. Enamel defects on whole teeth that could be imaged with high contrast with visible light were transparent in the NIR. This study suggests that PS-OCT and NIR methods may potentially be used as tools to assess the severity and extent of enamel defects.