Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Brazilian Schoolchildren Aged 8 to 10 Years

ABSTRACT Objective: To assess the impact of Molar Incisor Hypomineralization (MIH) and confounding factors on oral health-related quality of life (OHRQoL) according to the perception of 8 to 10-year-old children and their parents/caregivers. Material and Methods: A cross-sectional study including 403 students aged 8-10 years was carried out, in which OHRQoL was measured using the Child Perceptions Questionnaire administered to both children and parents/caregivers. The diagnosis of MIH was performed according to the previously proposed index. Dental caries experience, malocclusion, and sociodemographic factors were evaluated as confounders. Cluster analysis and Poisson regression with robust variance (p<0.05) were performed. Results: The prevalence of MIH was 13.4%. Parents/caregivers of children with MIH in incisors showed a higher impact prevalence in the emotional well-being domain (PR=1.92; 95%CI=1.16-3.19). Children with hypoplasia had a higher prevalence of negative impact on OHRQoL in the oral symptoms domain (PR=1.51; 95%CI=1.03-2.23). According to the perception of parents/caregivers, dental caries experience had a negative impact on the quality of life of students in the emotional well-being domain (PR=4.19; 95%CI=1.06-16.49) and in the total questionnaire score (PR=3.21; 95%CI=1.06-9.71). Conclusion: According to the perception of parents/caregivers, children with MIH in incisors showed a greater impact on OHRQoL. Additionally, the presence of hypoplasia affected the self-perception of OHRQoL in children, and caries experience influenced the OHRQoL of children, as perceived by parents/caregivers.

Prevalence of Dental Fear and its Association with Painful Oral Conditions in Adolescents

ABSTRACT Objective: To estimate the prevalence of dental fear and evaluate its association with dental caries and with Molar Incisor Hypomineralization (MIH) in schoolchildren aged 11-14 years. Material and Methods: A cross-sectional study was conducted with 375 adolescents in Campina Grande, Brazil. Socioeconomic and oral health information was collected, while dental fear was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The diagnosis of dental caries and MIH was performed by three trained examiners (κ ≥ 0.61) using the International Caries Detection & Assessment System - ICDAS II and a previously validated index, respectively. Data were descriptively analyzed using the Chi-Square, Fisher's Exact, and Poisson regression tests with robust variance (p<0.05). Results: The prevalence of dental fear was 18.4%, and the mean CFSS-DS total score was 28.96 ± 8.92. After adjusting for covariates family structure, schooling of parents/guardians, type of dental health service and dental pain in the last six months, the prevalence of dental fear was associated with dental pain in the last six months (PR=2.03; 95%CI=1.31-3.16; p=0.002). Conclusion: Although no association was found between dental fear, dental caries and MIH in adolescents, those who experienced dental pain in the last six months had a higher prevalence of dental fear.

Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization

ABSTRACT Objective: To evaluate an imaging protocol for use as a diagnostic and calibration tool for dentists before and after practical activity. Material and Methods: Thirty photos of children's teeth with or without changes in dental enamel were selected and evaluated by a group of experienced dentists previously calibrated to establish the diagnosis defined as the gold standard. After instructions, the images were shown to a group of postgraduate dentists for free identification of dental changes. Subsequently, a lecture on molar incisor hypomineralization (MIH) was carried out, and, at 14 days and all calibration was performed using the criteria previously. The retest was performed at 28 days. After experience in clinical activity in the following two weeks, the post-test was performed at 49 days. Data were analyzed using Cohen's kappa coefficient. Results: Theoretical learning on the subject showed low inter-examiner agreement when the diagnosis of defects was made from images obtained from intraoral photographs. After clinical practice, there was greater intra-examiner agreement. After theoretical training, dentists started to identify different types of enamel alteration, although with low agreement between them. Conclusion: Clinical experience in theoretical and imaging training favored the identification of defects. However, it is necessary to improve the protocol to establish a reliable and viable diagnostic method for calibration in MIH.

Rehabilitation Treatment in Pediatric Patients with Molar Incisor Hypomineralization: A Scoping Review

ABSTRACT Objective: To identify the available evidence on the different treatment types for the rehabilitation of MIH-affected teeth in children. Material and Methods: A search was carried out in Pubmed, Cochrane Library, Epistemonikos, Lilacs and Google Scholar. Observational studies published until June 2022 were included. Two reviewers independently screened studies and extracted data. Results: 1593 studies were screened and a total of 38 articles were included, which were mainly case reports published in Brazil. Most included studies concluded that the evaluated treatment was "beneficial" or "probably beneficial". Reported treatments included: glass ionomer cements (GIC), composite resin restorations, preformed metal crowns, laboratory fabricated crowns, microabrasion management of incisors and resin infiltration. Conclusion: Successful treatment options have been identified, such as GIC as a provisional restoration for severe cases and for uncooperative children; restorations with composite, indirect restorations, or preformed metal crowns also seem suitable treatment options for young patients diagnosed with MIH. There is still little evidence to support an approach for anterior teeth affected by MIH.

Knowledge of Dentists about Hypomineralization Enamel Defects: A Cross-Sectional Study

ABSTRACT Objective: To evaluate a group of Brazilian dentists on their knowledge of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molars (HSPM) related to clinical aspects, consequences, and diagnostic criteria. Material and Methods: In this cross-sectional, the participants were invited by e-mail and Whatsapp® to answer a questionnaire about their knowledge of hypomineralization enamel defects (MIH/HSPM) on the Google Forms® platform. The questionnaire comprised eight questions about personal data and multiple-choice questions about their knowledge concerning clinical aspects, diagnostic criteria of MIH/HSPM and differential diagnosis through clinical images. Chi-square test was applied with the significance level set at 5%. Results: Most participants (n = 492; 91.1%) reported having knowledge about MIH/HSPM. The general dentists gave more incorrect answers (n = 40; 65.6 %;) about dental tissues affected by MIH/HSPM. Overall, 83.3% of the dentists gave the correct answer to which dentitions are associated with this condition. In addition, most dentists presented knowledge about the consequences related to possible fractures (n= 487; 90.2%) and about an increased risk of caries (n= 479; 88.9%) in the affected teeth. Regarding the differential diagnosis performed through clinical images, most participants gave incorrect answers (p≤0.001). Conclusion: The participants presented knowledge about the dentition associated with this condition and possible consequences related to the teeth affected by MIH/HSPM; however, they showed difficulties concerning clinical diagnostic criteria.

Ocorrência e severidade da hipomineralização molar-incisivo em crianças e adolescentes: um estudo de painéis seriados / Occurrence and severity of molar-incisor hypomineralization in children and adolescents: a serial panel study

Introdução: A Hipomineralização Molar-Incisivo (HMI) é um defeito de desenvolvimento do esmalte, de origem sistêmica, que afeta pelo menos um primeiro molar permanente, podendo estar associado aos incisivos permanentes. Clinicamente é caracterizada como opacidades demarcadas de esmalte que podem variar de coloração (branco-creme ou amarelo-marrom). Objetivo: Estimar a ocorrência e a severidade da HMI em crianças e adolescentes e identificar os possíveis fatores associados à ocorrência da HMI. Metodologia: Foi realizado um estudo transversal em painéis seriados (2002 a 2011) e (2012 a 2021) que utilizou 230 prontuários de pacientes na faixa etária entre 06 e 12 anos, submetidos ao tratamento ortodôntico na Associação Brasileira de Odontologia entre os anos de 2002 e 2021. Os critérios diagnósticos utilizados foram a presença ou a ausência de opacidades demarcadas, restaurações atípicas, fraturas pós-irruptivas e extração de molar devido à HMI. Os dados coletados digitados e processados no programa SPSS, tratados estatisticamente através do teste do Qui-Quadrado para um nível de confiança de 95%. Resultados: A ocorrência de HMI em todo o período estudado foi de 26 casos dentre os 230 prontuários avaliados (o que representa 11,3% com IC de 95% de 7,21 a 15,39%). Desses, 03 casos são severos, o que equivale a 11,5% (com IC 95% de 5,00 a 18,00%). Foi observada uma associação da ocorrência da HMI com as variáveis gênero (masculino), idade (06 a 10 anos) e ano em que a documentação foi realizada (2012 a 2021). Conclusão: Esse trabalho evidencia que embora a ocorrência de HMI seja baixa em crianças e adolescentes de 06 a 12 anos, ela vem aumentando nos últimos anos. O percentual de indivíduos do gênero masculino e mais jovens com HMI é maior, apontando uma tendência de aumento da ocorrência de HMI nos próximos anos. Além disso, a maioria dos casos são leves, com um envolvimento maior de dentes molares em relação aos incisivos e de molares e incisivos maxilares em relação aos mandibulares. Esses achados são importantes para ajudar a formular estratégias para prevenir ou reduzir as consequências da HMI (AU).

Introduction: Molar-Incisor Hypomineralization (MIH) is an enamel development defect of systemic origin that affects at least one permanent first molar and may be associated with permanent incisors. Clinically, it is characterized as demarcated enamel opacities that can vary in color (white-cream or yellow-brown). Objective: To estimate the occurrence and severity of MIH in children and adolescents and identify possible factors associated with the occurrence of MIH. Methodology: A crosssectional study was carried out in serial panels (2002 to 2011) and (2012 to 2021) using 230 medical records of patients aged between 6 and 12 years, undergoing orthodontic treatment at the Brazilian Dental Association between 2002 and 2021. The diagnostic criteria used were the presence or absence of demarcated opacities, atypical restorations, post-rupturing fractures and molar extraction due to HMI. The collected data were typed and processed in the SPSS program, statistically treated using the chi-square test at a confidence level of 95%. Results: The occurrence of MIH throughout the study period was 26 cases among the 230 medical records evaluated (which represents 11.3% with a 95% CI of 7.21 to 15.39%). Of these, 03 cases are severe, which is equivalent to 11.5% (with CI 95% from 5.00 to 18.00%). An association was observed between the occurrence of MIH with the variables gender (male), age (06 to 10 years old) and year in which the documentation was carried out (2012 to 2021). Conclusion: This work shows that although the occurrence of MIH is low in children and adolescents from 6 to 12 years old, it has been increasing in recent years. The percentage of male and younger individuals with HMI is higher, indicating an increasing trend in the occurrence of HMI in the coming years. In addition, most cases are mild, with greater involvement of molar teeth compared to incisors and maxillary molars and incisors compared to mandibular ones. These findings are important to help formulate strategies to prevent or reduce the consequences of HMI (AU).

Avaliação do conhecimento e condutas clínicas dos ortodontistas quanto à hipomineralização molar incisivo / Assessment of orthodontists' knowledge and clinical conduct regarding incisor molar hypomineralization

Introdução: A Hipomineralização Molar Incisivo (HMI) é um defeito qualitativo do esmalte dentário, que o torna frágil e poroso, podendo levar a interferências na prática ortodôntica. Assim, torna-se necessário que o ortodontista conheça essa alteração. Objetivo: Avaliar o nível de conhecimento e as condutas clínicas dos ortodontistas em relação à HMI. Metodologia: Foi realizado um estudo observacional transversal, entre ortodontistas brasileiros para avaliar suas práticas e seus conhecimentos prévios sobre a HMI. Para isso, foi desenvolvido um questionário que contemplava perguntas sobre o diagnóstico da HMI, experiência clínica e condutas ortodônticas frente à essa condição. O questionário foi validado por odontopediatras através do método Delphi, e enviado para ortodontistas de todas as regiões do Brasil. Foram excluídos desse estudo ortodontistas que residiam fora do país, e aqueles que estavam impedidos de exercer a especialidade temporariamente. No total, foram consideradas 351 respostas. Resultados: Apesar de 80,1% dos ortodontistas afirmarem conhecer a HMI, 44,2% assumiram não sentir segurança na realização de seu diagnóstico. Não houve associação significativa entre o nível de conhecimento desses profissionais e as variáveis sociodemográficas (p>0,05), com exceção da variável sexo, onde o feminino apresentou um conhecimento superior em relação a HMI, quando comparado ao masculino (p<0,05). A HMI tem sido notada por 74,4% dos participantes em seu dia-a-dia clínico, e 80,3% afirmaram que estas alterações afetam diretamente suas práticas ortodônticas. Conclusão: Apesar dos ortodontistas conhecerem a HMI, eles não possuem domínio total das suas características e peculiaridades. Não há na literatura protocolos ideais para a conduta de colagem, cimentação e descolagem de acessórios ortodônticos em dentes com HMI, o que evidencia a necessidade de mais estudos nesse sentido (AU).

Introduction: Molar Incisor Hypomineralization (MIH) is a qualitative defect of dental enamel, which makes it fragile and porous, and can interfere with orthodontic practice. Thus, it is necessary for the orthodontist to know this enamel change. Aim: To assess the level of knowledge and clinical practices of orthodontists in relation to MIH. Methodology: We performed a cross-sectional observational study among brazilian orthodontists to evaluate their practices and previous knowledge regarding MIH. We developed a questionnaire including questions about MIH diagnosis, clinical experience and orthodontic approaches regarding MIH. The questionnaire was validated by pediatric dentists (using the Delphi method) and sent to orthodontists acting in all brazilian regions. Orthodontists who did not reside in Brazil and those who were temporarily unable to practice the speciality were excluded from this study. At total, responses from 351 orthodontists were considered. Results: Although 80.1% orthodontists claimed to know the HMI, 44.2% said they did not feel confident in carrying out their diagnosis. There was no significant association between the level of knowledge of these professionals and the sociodemographic variables (p>0.05), with the exception of the gender variable, where females showed superior knowledge regarding MIH, when compared to males (p<0,05). The HMI has been noticed by 74.4% of the participants in their clinical routine, and 80.3% stated that these changes directly affect their orthodontic practices. Conclusion: Although orthodontists know the MIH, they do not fully master its characteristics and peculiarities. There are no ideal protocols in the literature for the conduct of bonding, cementing and debonding of orthodontic accessories in teeth with MIH, which highlights the need for further studies in this regard (AU).

Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

Abstract Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children.

Prevalence and predisponent factors of molar-incisor hypomineralization in primary dentition

Aim: To evaluate the prevalence and predisposing factors for hypomineralization of second molars in children in primary dentition. Methods: A questionnaire was applied to parents to analyze predisposing factors and to assist in the diagnosis of hypomineralization in children between 2 and 6 years old, followed by an intraoral examination based on indices of non-fluorotic enamel defects in the primary dentition, according to the "Modified Index DDE" to determine demarcated opacity and HSPM presence / severity index to assess hypomineralization. Children from public and private schools were dived into two groups: if they presented HSPM-Group 1 (G1) and if they did not have HSPM-Control group (CG). Results: The most frequent predisposing factors associated with the child were Illness in the first year of life (X2= 6.49; p=0.01) and antibiotic use in the first year of life (X2= 41.82; p= 0.01). The factors associated with the mother were hypertension (X2= 9.36; p=0.01), infections during pregnancy (X2=14.80; p=0.01) and alcohol consumption during pregnancy (X2=97.33; p=0.01). There was a prevalence of 3.9% of HSPM in 14 children, with statistical difference regarding gender (X2 = 4.57; p <0.05), with boys presenting a higher frequency. In G1 hypomineralization was of the type with demarcated opacity, with more prevalent characteristics the yellowish spot, with moderate post-eruptive fracture and acceptable atypical restorations. All lesions were located in the labial region with 1/3 of extension. Conclusion: The prevalence of HSPM in children between 2 and 6 years old was 3.9%, with a predominance in males, with tooth 65 being the most affected. There was an association between HSPM and infection in the first year of life, as well as the use of antibiotics and sensitivity in the teeth affected by the lesion. There was an association between HSPM and hypertension, infection and mothers' alcohol use during pregnancy

Técnica minimamente invasiva em lesão branca hipoplásica: relato de caso / Minimally invasive technique in hypoplastic white injury: case report / Técnica minimamente invasiva en lesiónblancahipoplástica: caso clínico

Introdução:As manchas dentárias, dentre elas a hipoplasia do esmalte,corresponde a um dos motivos que fazem com que os pacientes busquem alterações no seu sorriso.O tratamento proposto deve ser sempre o mais conservador possível e buscar devolver a autoestima do paciente. Objetivo:Este trabalho objetivou apresentarum relato de caso clínico de paciente do sexo feminino, 26 anos, insatisfeita com a estética do seu sorriso por apresentar dentes escurecidos e hipoplasia de esmalte na face vestibular, em incisivo superior.Descrição do caso:Ao exame clínico foi observado escurecimento fisiológico e hipoplasia de esmalte no incisivo lateral superior esquerdo (22).O plano de tratamento proposto foi clareamento dental pela técnica associada (técnica de consultório + técnica caseira), remoção da mancha hipoplásica de formaminimamente invasiva e restauração em resina composta direta. Conclusões:Através de um correto diagnóstico, associado a uma técnica e seleção de material adequado, foi possível conseguir excelência estética com preservação de estrutura dentária sadia (AU).

Introduction:Dental stains, including enamel hypoplasia, correspond to one of the reasons that make patients seek changes in their smile. The proposed treatment should always be as conservative as possible and seek to restore the patient's self-esteem.Objective:This study aimedto present a clinical case report of a 26-year-old female patient, dissatisfied with the aesthetics of her smile as she had darkened teeth and enamel hypoplasia on the vestibular face, in anupper incisor. Case description:On clinical examination, physiological darkening and enamel hypoplasia were observedon the left upper lateral incisor (22). The proposed treatment plan was dental bleaching using the associated technique (In-office bleaching+ at-home bleaching), removal of the hypoplastic stain in a minimally invasive manner and restoration in direct composite resin.Conclusions:Through a correct diagnosis, associated with a technique and selection of suitable material, waspossible to achieve aesthetic excellence with preservation of healthy dental structure (AU).

ntroducción: Las manchas dentales, incluida la hipoplasia del esmalte, corresponden a una de lasrazones que hacenquelos pacientes busquencambios em susonrisa. El tratamiento propuestosiempredebe ser lo másconservador posible y tratar de restablecerla autoestima del paciente.Objetivo: Este estudio tuvo como objetivo presentarun informe de caso clínico de una paciente de 26 años de edad, insatisfechacon la estética de susonrisa, ya que habíaoscurecidolosdientes y la hipoplasia del esmalte en lasuperficie vestibular, en el incisivo superior.Descripcióndel caso: Enelexamen clínico, se observó oscurecimiento fisiológico e hipoplasia del esmalte en el incisivo lateral superior izquierdo (22). El plan de tratamiento propuestofueel blanqueamiento dental utilizando la técnica asociada (técnica de consultorio + técnica casera), eliminación de la mancha hipoplásica de maneramínimamente invasiva y restauraciónen resina compuestadirecta. Conclusiones: A través de un diagnóstico correcto, asociado con una técnica y selección de material adecuado, fueposible lograr laexcelencia estética conlapreservación de una estructura dental sana (AU).

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

Abstract This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.

Inheritance pattern of molar-incisor hypomineralization

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

What are the Systemic Factors Associated with the Molar-Incisor Hypomineralization Etiology?

ABSTRACT Objective: To evaluate the systemic factors associated with Molar-Incisor Hypomineralization (MIH) etiology. Material and Methods: A total of 731 8-year-old schoolchildren enrolled in the public school system in Curitiba, Brazil, was randomly selected. The MIH diagnosis was performed by calibrated examiners (Kappa >0.80) according to the European Academy of Pediatric Dentistry criteria (2003). The systemic factors were collected through a semi-structured questionnaire and applied to the children's mothers, addressing the medical history from pregnancy to the first three years of children's life. Associations were analyzed by Poisson regression analysis with robust variance (p<0.05). Results: The systemic factors in the prenatal and perinatal periods were not associated with MIH (p>0.05). The children who used medications during the first years of life had a significantly higher prevalence of MIH (PRc = 2.18 CI = 95% 1.06-4.48; p=0.033). Conclusion: The use of medications during the first three years of children's life is associated with a higher prevalence of MIH.

Dentists' Knowledge and Clinical Experience towards Molar-Incisor-Hypomineralization in Iran

ABSTRACT Objective: To determine the knowledge and clinical experience of dentists regarding MIH in Kerman/Iran. Material and Methods: In this cross-sectional study, a census sampling method was used, and all dentists registered in Kerman medical council were asked to participate in the study. A validated and reliable researcher administered questionnaire was used to determine participants' demographic characteristics, knowledge, and clinical experience. The association between knowledge score and demographic variables was determined using an independent t-test and ANOVA. The level of significance was set as 0.05. Results: Overall, 400 specialized and general dentists in Kerman completed the questionnaire. The mean knowledge score of dentists was 6.6±1.9 of 11. Female dentists' knowledge was higher than male dentists (p<0.05). General dentists had a higher level of knowledge regarding MIH compared to specialists (p<0.05). Overall, 79.5 % had been faced with MIH during their practice years. After confronting MIH teeth, 48.8% of dentists referred patients to specialists for treatment. Providing aesthetics was considered the most difficult part of treatment (43.2%). Resin composite was the most favorable dental material for treating MIH (60.9%). Conclusion: Although most dentists in Kerman had encountered MIH defects during their clinical practice, they did not have enough knowledge of the defect and required education on all aspects of MIH diagnosis and management. Younger dental practitioners, general dentists and females presented higher knowledge of MIH.

Clinical and Molecular Disorders Caused by COVID-19 During Pregnancy as a Potential Risk for Enamel Defects

ABSTRACT This paper discusses the potential risk that COVID-19 generates for the development of enamel defects. This hypothesis was built based on the etiopathogenesis of enamel defects and the relationship with the symptom's characteristic of COVID-19. Pregnancy is a critical period for the child's development; exposure to pathological agents can cause systemic imbalances and risks of adverse perinatal and prenatal outcomes. The main clinical symptoms of this disease and its association with that dental outcome were considered. Fever, breathing, cardiovascular disorders, and diarrhea were related as potential etiological factors of ameloblast metabolism imbalance, which can interfere qualitatively and quantitatively in the development, maturation and mineralization of the tooth enamel. Molecular disorders derived from COVID-19, as well as their clinical symptoms, can be considered potential risk factors for the development of enamel defects. Individuals with enamel defects experienced high stress levels during pregnancy or early childhood. The approach adopted may help build new research to ensure understanding of the etiology of the development of dental enamel defects and its relationship with COVID-19. However, longitudinal studies need to be conducted to confirm the association between COVID-19 and adverse events during pregnancy.

Dental Fear in Children: Association with Dental Caries and Molar Incisor Hypomineralization

Abstract The aim of this study was to investigate the prevalence of dental fear and to evaluate its association with dental caries and molar incisor hypomineralization (MIH) in schoolchildren aged 8-10 years from a municipality in Northeastern Brazil. Data from 466 students enrolled in urban public schools in a cross-sectional study were collected. Parents/guardians answered a questionnaire addressing sociodemographic characteristics, dental fear was measured by means of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and clinical examinations were performed by three calibrated examiners for diagnosis of dental caries, using the International Caries Detection & Assessment System - ICDAS II and a previously validated index for MIH. Descriptive data analysis was performed, and associations between dental fear, dental caries and MIH were analyzed using robust Poisson regression for complex samples (p<0,05). The prevalence of dental fear was 21.6%, and the mean total CFSS-DS score was 29.97 (CI 95%=29.05-30.89). In the multivariate adjusted model, the prevalence of dental fear was associated to family income (PR=1.78; CI 95%=1.02-3.08; p= 0.041). Monthly family income was associated with dental fear in children, whereas dental caries and MIH were not associated with dental fear.

Resumo O objetivo deste estudo foi investigar a prevalência de medo odontológico e avaliar sua associação com a cárie dentária e a Hipomineralização molar-incisivo (HMI), em escolares de 8 a 10 anos, em um município da região Nordeste do Brasil. Foram coletados dados de 466 estudantes matriculados em escolas públicas urbanas, em um estudo transversal. Os pais/responsáveis responderam a um questionário abordando características sociodemográficas, o medo odontológico foi mensurado por meio do Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), e os exames clínicos foram realizados por três examinadores calibrados para o diagnóstico de cárie dentária, utilizando o índice International Caries Detection & Assessment System (ICDAS II) e, por um índice previamente validado, para HMI. Foi realizada a análise descritiva dos dados e as associações entre medo odontológico, cárie dentária e HMI foram avaliadas pela regressão robusta de Poisson para amostras complexas (p<0,05). A prevalência de medo odontológico foi de 21,6%, e o escore médio total do CFSS-DS foi de 29,97 (IC 95%=29,05-30,89). No modelo multivariado ajustado, a prevalência de medo odontológico esteve associada à renda familiar (RP=1,78; IC 95%=1,02-3,08; p= 0,041). A renda familiar mensal foi associada ao medo odontológico em crianças, enquanto a cárie dentária e a HMI não foram associadas ao medo odontológico.

Dental trauma with intrusive luxation and six-year monitoring: clinical case report / Traumatismo dentário com luxação intrusiva com acompanhamento de seis anos: relato de caso clínico

Objective: this study is designed to report a clinical intrusion case, which exhibited enamel hypoplasia on the crown of tooth 11 and which underwent clinical and X-ray monitoring for six years. Case report: A threeyear- old female patient exhibited intrusion of deciduous teeth 51, 52, 61, and 62. After X-ray, it was detected that teeth 51 and 61 had perforated the nasal cavity floor, but all four teeth had re-erupted and began to be monitored. After six months, teeth 51 and 61 exhibited bone loss in the interproximal area, as well as mobility, which led to tooth extraction. Teeth 52 and 62 re-erupted in a satisfactory position, and exhibited no signs and symptoms of infection, periapical alteration, or mobility. These teeth were therefore maintained in the arch. After six years, it was detected that tooth 11 had erupted with enamel hypoplasia. Final considerations: Longterm clinical and X-ray control proved essential, as it allowed for the early diagnosis of potential alterations, and minimized potential sequelae to the permanent teeth.(AU)

Objetivo: relatar um caso clínico de intrusão com acompanhamento clínico e radiográfico de 6 anos, que apresentou hipoplasia de esmalte na coroa do dente 11. Relato de caso: paciente de 3 anos, sexo feminino, apresentou intrusão dos dentes decíduos 51, 52, 61 e 62. Após radiografia, foi detectado que os dentes 51 e 61 tinham perfurado o soalho da fossa nasal, porém, ocorreu re-erupção dos 4 dentes e foi realizado acompanhamento. Após 6 meses, nos dentes 51 e 61, foram observadas perda óssea na região interproximal e mobilidade, optando-se pelas exodontias. Os dentes 52 e 62 re-erupcionaram em posição satisfatória e com ausência de sinais e sintomas de infecções, alterações periapicais e mobilidade, sendo mantidos no arco. Após 6 anos, foi observado que o dente 11 erupcionou apresentando hipoplasia de esmalte. Considerações finais: mostrou-se essencial o controle, clínico e radiográfico, em longo prazo, diagnosticando precocemente possíveis alterações e minimizando sequelas que podem acometer os dentes permanentes.(AU)

The effect of amoxicillin on dental enamel development in vivo

Abstract The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.

White spots on tooth enamel in mixed dentition / Manchas brancas em esmalte dentário na dentição mista

Aim: To determine the prevalence, predisposing factors of white spots on enamel and the effectiveness of treatment using the microabrasion technique. Method: A study was developed in children between the ages of 6 and 12 of both genders, enrolled in municipal public schools. Epidemiological questionnaire was applied to the participants and parents or guardians to investigate the predisposing factors of the lesions on permanent teeth during the mixed dentition. Oral examination of the children was carried out, and for those children in whom white spot lesions were found, dental treatment was provided by the microabrasion technique in the incisors and/ or first permanent molars to prevent the evolution to a caries lesion with cavitation, since the enamel structure was damaged. Results: The majority of the sample had from 1% to 24% of the enamel affected by the white spots. The possible predisposing factors of white spots were systemic infections, trauma or caries with pulp involvement in a deciduous tooth. The treatment was effective in 16 children and for the remaining two the restorative treatment was performed. Conclusion: The prevalence of white spot lesions found in enamel was 3.95%, with a higher prevalence in females. Regarding predisposing factors, most children had some infectious diseases and frequently took antibiotics and anti inflammatory drugs. The permanent right upper central incisor was the most affected. The treatment proved to be effective in most children possibly because the lesion is located more superficially in the enamel (AU)

Objetivo: Determinar a prevalência, os fatores predisponentes de manchas brancas no esmalte dentário e a eficácia do tratamento pela técnica de microabrasão. Método: Foi desenvolvido um estudo em crianças na faixa etária dos 6 aos 12 anos de ambos os gêneros, matriculados em 3 escolas públicas municipais. Questionário epidemiológico foi aplicado aos participantes e aos pais ou responsáveis para investigar os fatores predisponentes das lesões em dentes permanentes durante a dentição mista. Realizou-se o exame bucal das crianças e nas que foram constatadas lesões de mancha branca foi proporcionado o tratamento odontológico pela técnica de microabrasão, nos incisivos e/ou primeiros molares permanentes, impedindo a evolução para uma lesão de cárie com cavitação, uma vez que a estrutura do esmalte estava danificada. Resultados: A maioria da amostra apresentou de 1% a 24% do esmalte atingido pelas manchas brancas. Os possíveis fatores etiológicos das manchas brancas foram infecções sistêmicas, trauma ou cárie com envolvimento pulpar em dente decíduo. O tratamento foi eficaz em 16 crianças e em duas restantes foi realizado o tratamento restaurador. Conclusão: A prevalência de lesões de manchas brancas encontradas em esmalte foi 3.95% com maior predominância no gênero feminino. Com relação aos fatores predisponentes, a maioria das crianças tiveram algumas doenças infecciosas e fizeram uso de antibióticos e anti-inflamatórios. O incisivo central superior direito permanente foi o mais acometido. O tratamento mostrou-se eficaz na maioria das crianças, possivelmente devido à localização da lesão ser superficial no esmalte (AU)

Prevalence of Molar Incisor Hypomineralisation Among School Children aged 7-12 years in Tunis, Tunisia

Abstract Objective: To evaluate the prevalence and the characteristics of Molar Incisor Hypomineralisation (MIH) in 7-12-year-old children in Tunis, Tunisia. Material and Methods: This study was designed as a cross-sectional study, in which school children aged 7 to 12 years were included. A total of 510 children (257 girls and 253 boys) who had their first permanent molar and incisors were evaluated using the 2003 European Academy of Paediatric Dentistry (EAPD) recommendation criteria were examined. Descriptive data analysis and Pearson's chi-squared test were performed (p<0.05). Results: A total of 510 children were included in the study. MIH was present in 35.4 % of our study population. Boys exhibited slightly higher MIH (19,4%) and Post Eruptive Breakdown (PEB) (7,3%) prevalence compared to girls, but the difference was not statistically significant (p=0.07). Moreover, demarcated opacities were more prevalent than PEB. More precisely, the main prevalence without PEB was MIH with white/creamy demarcated opacities, which was more frequent than yellow/brown demarcated opacities (p<0.05). Conclusion: The prevalence of MIH in Tunis was 35.4%, with no difference between girls and boys. The main MIH type prevalence was white/creamy demarcated opacities without PEB.