Diagnosing celiac disease in children using oral manifestations.

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

Association of Molar Incisor Hypomineralization with Hypomineralized Second Primary Molars: An Updated Systematic Review with a Meta-Analysis and Trial Sequential Analysis.

INTRODUCTION: There is a correlation between molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM), but this relationship has not been definitively confirmed. The purpose of this systematic review and meta-analysis was to reevaluate whether children with HSPM are more affected by MIH than non-HSPM children. METHODS: A systematic search was conducted in four databases (PubMed, Embase, Web of Science, and the Cochrane Library) for literature, published up to December 2022. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk-of-bias assessment of all included cohort studies and case-control studies was assessed by the Newcastle-Ottawa Scale (NOS), and cross-sectional studies were assessed using the Agency for Healthcare Research Quality (AHRQ) scale. RevMan 5.4 software was used for all data analyses, with odds ratios (ORs) and 95% confidence intervals (CIs) as the effect measures. Sensitivity and subgroup analyses were conducted to identify the potential sources of heterogeneity among the studies. Publication bias was tested and corrected by funnel plots and Egger's test. Trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software to control for type-1 and type-2 errors. RESULTS: A total of 12 studies involving 8,944 children were included in this meta-analysis. Compared with the non-HSPM group, the HSPM group had an increased likelihood of MIH (OR = 10.90, 95% CI = 4.59-25.89, p < 0.05). All the included studies were of moderate-to-high quality. TSA and sensitivity analyses suggested the robustness of this outcome. CONCLUSION: This systematic review demonstrated a certain correlation between HSPM and MIH, suggesting that HSPM can play a predictive role in the occurrence of MIH. Further high-quality, multicenter, and large-sample longitudinal studies are highly recommended.

Incidence and treatment for hypomineralization of incisor and molar among school going Indian children.

The presence of molar incisor hypomineralization (MIH) raises the likelihood of enamel degradation, which in turn raises the risk of plaque buildup and dental caries. Individuals impacted by this illness frequently incur large long-term costs. Therefore, it is of interest to evaluate prevalence and treatment need of MIH in school going children. Hence, 3030 school going students were included in this study. Considering the WHO 1997 guidelines for caries severity and the requirement of therapy for the damaged teeth and criteria for MIH, a full mouth visual assessment of moist teeth was conducted for every student. The overall prevalence of MIH was 174 (7.9%). Preventive caries restricting therapy was needed in 42(6.2%) maxillary right first molar,30(4.5%) maxillary left first molar, 30 (4.5%) mandibular right first molar, 36 (5.4%) in mandibular left first molar. Data shows that an incidence rate of 7.4 percent was noted, with a larger propensity among male children and a predominant impact on mandibular molars.

Analysis of the stomatognathic system functions and mastication muscles in children affected by molar hypomineralization (MH): a cross-sectional study.

PURPOSE: To analyze the functions of the stomatognathic system in children with or without molar-incisor hypomineralization (MIH). METHODS: For this cross-sectional study, 72 children aged 6-12 years were recruited and divided in two groups: with MIH (G1) and without MIH (G2). T-SCAN was used to verify the distribution of occlusal contacts, gnathodynamometer to measure maximum molar bite force, and Iowa Oral Pressure Instrument (IOPI) to assess the strength of facial expression muscles. The t test and paired t test (p ≤ 0.05) were used for statistical comparisons. RESULTS: The molars affected by MIH exhibited lower distribution of occlusal forces (p < 0.001) and lower maximum molar bite force (p < 0.05) compared to the molars in the control group. However, there was no difference between the MIH-affected sides compared to the unaffected side, nor between the molars affected by MIH and their antagonists (p > 0.05). There were no differences in the forces of the facial expression muscles between the groups. CONCLUSIONS: These findings suggest that MIH significantly impacts occlusal force distribution and bite force, but not facial expression musculature.

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries.

OBJECTIVE: Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. METHODS: A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. RESULTS: When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167). CONCLUSION: Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. CLINICAL RELEVANCE: The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Which are the clinical consequences of Molar Incisor hypomineralization (MIH) in children and adolescents? Systematic review and meta-analysis.

OBJECTIVE: This systematic review was conducted to address the following research question: "What are the clinical consequences (outcome) of Molar Incisor Hypomineralization (MIH) (exposure) in children and adolescents (population/patient)?". MATERIAL AND METHODS: After defining the strategy, a search was performed in different databases (MEDLINE via Pubmed, Cochrane Library, BBO, LILACS, Scopus, Web of Science, Embase) and Grey literature in August 2023. Cross-sectional observational studies that identified clinical consequences of MIH (dental caries, post-eruptive structural loss, atypical restorations, hypersensitivity and tooth extraction) were included. The risk of bias was assessed following the Joanna Briggs Institute protocol for cross-sectional studies. Meta-analyses were conducted for each outcome, taking into account the number of patients and teeth. The effect measure considered was the prevalence; random-effects model was adopted. Heterogeneity was assessed using I2 statistics and prediction intervals (PI). RESULTS: A total of 903 studies were identified; 41 were selected for qualitative analysis and 38 for quantitative analysis. Twenty eight studies were classified as presenting uncertain risk of bias, 11 as low risk and 3 as high risk of bias. The prevalence levels, ranked from highest to lowest and considering the tooth and patient units, respectively, were: caries lesions (0.252 - 95% CI 0.158-0.375; 0.512 - 95% CI 0.385-0.639); hypersensitivity (0.286 - 95% CI 0.190-0.407; 0.417 - 95% CI 0.197-0.674), post-eruptive fracture (0.125 - 95% CI 0.099-0.158; 0.257 - 95% CI 0.145-0.412); atypical restorations (0.048 - 95% CI 0.030-0.077; 0.167 - 95% CI 0.096 - 0.274); tooth extraction (0.012 - 95% CI 0.007-0.019; 0.090 - 95% CI 0.019 - 0.331). All meta-analyses resulted in heterogeneity greater than 85%, with the exception of the outcome "tooth extraction" according to the tooth unit (I2 = 57.83). This heterogeneity may be attributed to factors such as differences in the location where the study was realized, the socioeconomic conditions of the studied population, the asymmetric nature of MIH, and patient age. CONCLUSION: The most common consequences of MIH are caries lesions, hypersensitivity, and post-eruptive breakdown. (PROSPERO:CRD42020201410).

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

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

Proteomic profiling of human dental enamel affected by molar incisor hypomineralisation of different clinical severity grades: an in vitro study.

PURPOSE: The aim of this study was to explore the potential to profile and distinguish varying clinical severity grades of MIH, compared to normal enamel, using proteomics. METHODS: Liquid chromatography-mass spectrometry analyses were conducted on enamel samples of extracted teeth, from 11 children and adolescents, spanning an age range of 6-18 years. Enamel powder samples were collected from extracted, third molars (n = 3) and first permanent molars diagnosed with MIH (n = 8). The MIH tooth samples were categorized into subgroups based on clinical severity grade. The data were statistically analyzed using ANOVA and Welch's t test. RESULTS: Teeth affected by MIH exhibited a diverse array of proteins, each with different functions related to dental enamel, distinguishing them from their normal enamel counterparts. The application of microdissection combined with LC-MS techniques has revealed the potential to discern unique proteomic profiles among MIH-affected teeth, characterized by varying clinical severity grades. Both analyzed MIH groups displayed consistent trends in the presentation of biological processes, including underabundance of proteins primarily associated with cell organization and biogenesis. Furthermore, proteins linked to cell death were overabundant in both MIH groups. CONCLUSION: Proteomics enabled the detection and differentiation of various proteins across different clinical severity grades of MIH.

Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil.

PURPOSE: To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization. METHODS: Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05). RESULTS: 513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01). CONCLUSION: The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Home / Archives / Vol. 12 No. 1 (2024) / Articles SPATIAL DISTRIBUTION OF MOLAR INCISOR HYPOMINERALIZATION (MIH) OPACITIES IN FIRST PERMANENT MOLARS

Aim: To evaluate the spatial distribution of MIH opacities in first permanent molars (FPM). Materials and methods: an analysis of intraoral photographs of FPM with demarcated MIH opacities was conducted. The presence of opacity was computed in a digital matrix, discriminating the anatomical regions of the FPM surfaces. The frequencies of distribution of the opacities were descriptively analyzed through 227 FPM digital images of 89 children built in GIMP and Python and by Spearman correlation (= 0,05). Results: the occlusal surface was the most affected one (94% to 100%). In the upper FPM, the palatine surface was the second most affected one (84%-91%). In the lower FPM, the vestibular surface was the second most affected one (85%-80%). A similar pattern of opacity distribution was observed in the contralateral teeth. On smooth surfaces, opacities were more frequent in the regions closer to the occlusal surface than to the cervical one. Conclusion: MIH opacities were mostly present on occlusal, vestibular, and lingual/palatine surfaces, respectively. There is a possibility that the occurrences are in accordance with the chronology of dental formation.

Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial.

OBJECTIVES: This study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. METHODS: 112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. RESULTS: The caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. CONCLUSIONS: During the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. CLINICAL SIGNIFICANCE: Both SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. CLINICALTRIALS REGISTRATION NUMBER: NCT03862014.

Influence of different pre-treatments on the resin infiltration depth into enamel of teeth affected by molar-incisor hypomineralization (MIH).

OBJECTIVES: This in vitro pilot study aimed to evaluate whether different pre-treatments (demineralization, deproteinization, (chemo-)mechanical reduction of the surface layer) influence the penetration depth of a resin infiltrant into MIH-affected enamel compared to initial carious lesions. METHODS: Thirty extracted human permanent molars with non-cavitated initial carious lesions (n = 5) or MIH (n = 25) were chosen and randomly assigned to six experimental groups: IC: initial caries; M: MIH; MN: MIH, 5.25% sodium hypochlorite; MM: MIH, microabrasion; MA: MIH, air abrasion; MAN: MIH, air abrasion and 5.25% sodium hypochlorite. A modified indirect dual fluorescence staining method was adopted to assess the penetration depth (PD) of the resin infiltrant and the lesion depth (LD) by confocal laser scanning microscopy (CLSM). Exemplarily, scanning electron microscopic (SEM) images were captured. The relationship between group assignment and penetration/lesion depth was estimated using a linear mixed model incorporating the tooth as random effect (two observations/tooth). The significance level was set at p < 0.05. RESULTS: For MIH-affected molars, the mean PD (in µm; median, [minimum-maximum]) were M (178.2 [32.5-748.9]), MN (275.6 [105.3-1131.0]), MM (48.7 [0.0-334.4]), MA (287.7 [239.4-491.7]), and MAN (245.4 [76.1-313.5]). Despite the observed differences in PD between the groups, these could not be statistically verified (Bonferroni, p = 0.322). The percentage penetration was significantly higher for IC than for MIH groups (Bonferroni, p < 0.05). SIGNIFICANCE: Compared to IC, resin infiltration into MIH-affected enamel ist more variable. Different pre-treatments influence the resin penetration into developmentally hypomineralized enamel to a fluctuating level.

Dental Developmental Defects: A Pilot Study to Examine the Prevalence and Etiology in a Population of Children between 2 and 15 Years of Age.

Dental development defects (DDDs) are quantitative and/or qualitative alterations produced during odontogenesis that affect both primary and permanent dentition. The etiology remains unknown, being associated with prenatal, perinatal, and postnatal factors. The aims were to identify the possible etiological factors, as well as the prevalence of DDDs in the primary and permanent dentition in a pediatric population. Two hundred twenty-one children between 2 and 15 years of age, patients of the master's degree in Pediatric Dentistry of the Complutense University of Madrid, were reviewed. DDDs were observed in 60 children. Next, a cross-sectional, case-control study was carried out (60 children in the control group and 60 children in the case group). The parents or guardians completed a questionnaire aimed at identifying associated etiological factors. The prevalence of DDDs in patients attending our master's program in both dentitions was 27.15%. Otitis, tonsillitis, high fevers, and medication intake stood out as the most relevant postnatal factors among cases and controls. The permanent maxillary right permanent central incisor and the primary mandibular right second molar were the most affected; there were no differences in relation to gender. One out of three children who presented DDDs in the primary dentition also presented DDDs in the permanent dentition. Prenatal and postnatal etiological factors showed a significant relationship with DDD alterations, considered risk factors for DDDs in both dentitions.

Potential Association of Molar-Incisor Hypomineralization (MIH) with Dental Agenesis and Infraoccluded Deciduous Molars: Is MIH Related to Dental Anomaly Pattern (DAP)? An Observational Cross-Sectional Study.

Background: Dental Anomaly Pattern (DAP) is a collection of morphologic, numeric, and eruptive anomalies of teeth that are often observed together, suggesting a potential genetic relationship. Our objective was to assess the potential associations of Molar-Incisor Hypomineralization (MIH), a common developmental defect of enamel mineralization with a controversial etiology, with two specific components of DAP: (1) agenesis (AG) and (2) infraoccluded deciduous molars (IODM). Establishing such an association between MIH and one or both anomalies would provide evidence supporting a genetic link between MIH and DAP. Methods: We examined pretreatment intraoral standardized photographies and panoramic radiographs from 574 children aged 8-14 years, 287 having MIH and 287 without MIH, comparing the frequencies of AG and IODM in both groups. The subject samples were sourced from the databases of the orthodontic department at a university hospital. Results: The frequencies of AG in the MIH and non-MIH groups were 7% and 8%, respectively (p = 0.751). The corresponding frequencies of IODM were 27% and 19.2%, respectively (p = 0.082). That is, children with MIH did not exhibit an increased frequency of AG or IODM compared to those without MIH. Conclusions: These findings do not support the inclusion of MIH in DAP. Nevertheless, further analysis of possible associations is necessary to definitively validate or invalidate this hypothesis.

Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis.

OBJECTIVES: To determine the prevalence of dentin hypersensitivity (DH) and toothache in patients with Molar-Incisor Hypomineralization (MIH); and evaluate whether patients with MIH have greater likelihood of presenting DH/toothache than controls. DATA: Studies evaluating DH/toothache in patients with MIH were included. Studies focusing on other enamel defects were excluded. SOURCES: Eight databases, including grey literature, were searched in January 2024. STUDY SELECTION: The methodological quality of studies was assessed using the Joanna Briggs Institute checklist for Cross-sectional studies. Proportion and association meta-analyses, subgrouped by diagnostic methods, were conducted. The certainty of evidence was assessed using GRADE approach. RESULTS: Fifteen studies were included in the qualitative analysis and fourteen in the meta-analyses. Two studies fulfilled all items of the methodological quality checklist. The overall prevalence of DH/toothache among patients with MIH was 45 %. Prevalence rates of 30 %, 47 %, and 55 % were estimated based on proxy reports, self-reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22 %, ranging from 16 % to 29 % according to the diagnostic method. Patients with MIH demonstrated higher likelihood of presenting proxy reports of DH/toothache compared to those without MIH (OR: 1.51, 95 % CI [1.23-1.85], P < 0.01, I2: 0 %). The certainty of evidence was very low, mainly due to the low methodological quality of included studies and high inconsistency. CONCLUSIONS: The global prevalence of DH/toothache was 22 %, per tooth, and 45 % per patient. Estimates vary according to diagnostic methods. Patients with MIH showed higher likelihood of presenting proxy reports of DH/toothache than controls. CLINICAL SIGNIFICANCE: This systematic review contributes valuable information to the dental literature by assessing the prevalence and associated factors of DH/toothache in patients with MIH. The findings can guide future research, inform clinical practices and public policy makers, and ultimately improve the management of oral health of patients with MIH. REGISTRATION: PROSPERO CRD42023432805.

Celiac Disease-Related Enamel Defects: A Systematic Review.

INTRODUCTION: This systematic review aims to elucidate the intricate correlation between celiac disease (CD) and dental enamel defects (DED), exploring pathophysiological mechanisms, oral health implications, and a dentist's role in early diagnosis. MATERIALS AND METHODS: Following PRISMA guidelines, a comprehensive search from 1 January 2013 to 1 January 2024 across PubMed, Cochrane Library, Scopus, and Web of Science identified 153 publications. After exclusions, 18 studies met the inclusion criteria for qualitative analysis. Inclusion criteria involved study types (RCTs, RCCTs, case series), human participants, English language, and full-text available. RESULTS: The search yielded 153 publications, with 18 studies meeting the inclusion criteria for qualitative analysis. Notable findings include a high prevalence of DED in CD patients, ranging from 50 to 94.1%. Symmetrical and chronological defects, according to Aine's classification, were predominant, and significant associations were observed between CD severity and enamel defect extent. CONCLUSIONS: The early recognition of oral lesions, particularly through Aine's classification, may signal potential CD even in the absence of gastrointestinal symptoms. Correlations between CD and dental health conditions like molar incisor hypomineralization (MIH) emphasize the dentist's crucial role in early diagnosis. Collaboration between dentists and gastroenterologists is essential for effective monitoring and management. This review consolidates current knowledge, laying the groundwork for future research and promoting interdisciplinary collaboration for improved CD-related oral health outcomes. Further large-scale prospective research is recommended to deepen our understanding of these issues.

Assessment of diagnostic accuracy and reliability of reveal fluorescence dental loupes in detecting molar incisor hypomineralization in children.

BACKGROUND: Molar-Incisor Hypomineralization (MIH) poses challenges to accurate diagnosis, impacting children's oral health. Traditional methods exhibit limitations, necessitating innovative approaches. This study aimed to evaluate the reliability and diagnostic accuracy Reveal Fluorescence Dental Loupes (RFDLs) for the detection of MIH METHODS: This cross-sectional study, adhering to STRAD guidelines, involved 38 healthy children (age 7-9) with MIH. Ethical approval and informed consent were obtained. Microscope images and Reveal loupes were employed for examinations. Validity was assessed against microscope results, and inter- and intra-examiner reliability were measured using ICC and Kappa coefficients. Sensitivity, specificity, and overall accuracy were calculated, with an AUC-ROC analysis for discriminatory ability. RESULTS: Intra-examiner reliability scores were excellent (Examiner 1: ICC 0.92, Examiner 2: ICC 0.94). Inter-examiner reliability (Kappa 0.92) indicated almost perfect agreement. Reveal demonstrated high sensitivity (82.61 %) and specificity (92.59 %), with an overall accuracy of 88.70 %. AUC-ROC analysis supported its robust discriminatory ability (AUC: 0.871). CONCLUSIONS: Reveal Fluorescence Dental Loupes emerged as a promising diagnostic tool for accurate MIH detection, particularly in outreach settings. The study highlights the transformative impact of accessible and reliable diagnostic tools on pediatric oral health outcomes. While acknowledging limitations and the absence of a gold standard, the findings contribute to advancing MIH diagnostic capabilities. Further research in diverse populations is warranted for comprehensive validation.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study.

OBJECTIVES: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Possible Etiological Factors for the Development of Molar Incisor Hypomineralization (MIH) in Austrian Children.

BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental enamel defect that primarily affects the first permanent molars and sometimes the incisors. Its increasing prevalence worldwide has raised clinical concerns, yet its exact cause remains unknown. This study aimed to assess potential factors influencing MIH development by analyzing the medical history of children aged 6 to 12 years using a questionnaire. METHODS: This study included 100 children aged 6-12 years diagnosed with MIH during dental examination, and 100 age-matched children in the non-MIH (healthy) group from the Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna. The parents of the participants completed a two-page questionnaire regarding possible etiological factors of MIH. RESULTS: The data analysis involved 100 children with MIH (mean age 8.5; ±1.3; 52% female) and 100 children in the healthy group (mean age 9.2; ±1.3; 42% female). The optimized binary logistic regression analysis revealed a significant association between MIH development and cesarean-section delivery (OR = 3; CI = [1.5-6.2]) and sixth disease (roseola) (OR = 3.5; CI = [1.5-8.0]). CONCLUSIONS: This study suggests that cesarean-section delivery and sixth disease (roseola) might increase the likelihood of MIH development in children.

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children.

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.