Prenatal exposure to gestational diabetes mellitus increases developmental defects in the enamel of offspring.

BACKGROUND AND OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with short- and long-term maternal and perinatal repercussions. Our objective was to evaluate the long-term consequences of intrauterine exposure to hyperglycemia on Developmental Defects of Enamel (DDE) in offspring. RESULTS: Overall, 50 children of women with GDM and 250 children of normoglycemic women participated, the latter serving as controls. Children were examined at the age between 3 and 12 years. In addition to physical examination, two independent observers examined and rated photographs to identify specific types of DDE in a blinded fashion. Among offspring of mothers with GDM, rates of DDE (all types combined) and hypoplasia (specific type) were significantly higher (p<0.001, p = 0.04), in comparison to offspring of normoglycemic mothers. Considering only the affected teeth (1060 in GDM category; 5499 in controls), rates of DDE (all types combined) were significantly higher for total teeth (p <0.001) and deciduous teeth (p<0.001), but not permanent teeth. In specific types of DDE involving deciduous teeth, rates of demarcate opacity were significantly higher (p<0.001; canine and 2nd mandibular molars) and hypoplasia (p <0.001; 2nd maxillary molars and 2nd mandibular molars). In permanent teeth, the rate of diffuse opacity in association with GDM was significantly higher (p<0.001; maxillary central incisors and 1st maxillary molars). CONCLUSION: GDM was associated with the adverse effects of DDE on offspring. This study lays the foundation for future studies to determine the impact of GDM on long-term risk of DDE.

Impacto de la hipomineralización incisivo molar en la experiencia de caries en escolares de 6-12 años en Santiago, Chile / Molar incisor hypomineralisation and its impact on caries experienced by 6-12 year-old schoolchildren from Santiago, Chile

Objetivo: El objetivo de este estudio fue determinar las consecuencias clínicas expresadas en índices COPD y ceod y su relación con la presencia de hipomineralización incisivo molar (HIM) en una población de escolares de 6 a 12 años de la provincia de Santiago. Método: Este estudio de corte transversal fue realizado en 851 escolares de 6 a 12 años de la provincia de Santiago, quienes fueron evaluados por 2 dentistas calibrados. Con consentimiento de los tutores legales, los escolares fueron examinados, y se utilizaron los criterios diagnósticos para HIM de la Academia Europea de Odontopediatría (EAPD). La historia de caries fue determinada con COPD/ceod de acuerdo a los criterios de la OMS. Los datos fueron recolectados en una ficha especialmente diseñada para esto. Los datos fueron analizados con test «t¼ para muestras individuales (considerando p < 0,05). Resultados: Los escolares afectados por HIM tuvieron una media de COPD de 0,91 (±1,21) y una media de ceod de 1,98 (±2,48), el cual fue mayor que el COPD y ceod de escolares sin HIM (0,41 [±0,95] y 1,34 [±2,15] respectivamente). La diferencia entre ambos grupos fue estadísticamente significativa para COPD (p < 0,000) y ceod (p = 0,002). Conclusiones: Escolares de la provincia de Santiago de 6 a 12 años afectados con HIM presentaron mayor COPD/ceod que escolares sin HIM.

Objective. The aim of this study was to determine the clinical consequences, expressed in DMFT and dmft, and their relationship with Molar Incisor Hypomineralisation (MIH) in a population of schoolchildren of 6 to 12 years old in the Santiago Province. Method: A cross-sectional study was conducted on 851 schoolchildren between 6-12 years old from the Santiago Province were examined by two calibrated examiners. With informed consent from their parents, the schoolchildren were examined, and the European Academy of Paediatric Dentistry (EAPD) diagnostic criteria was used for MIH detection. Caries history was assessed with the DMFT/dmft score according to WHO criteria. Data was collected with a form specially designed for this study. Data was analysed using Student's t-test for individual samples and a post-hoc Bonferroni (P < .05). Results: The mean DMFT score in the MIH-affected schoolchildren was 0.91 (±1.21), with a mean dmft score of 1.98 (±2.48), which were greater than the scores in the non-MIH affected schoolchildren (mean DMFT score 0.41 [±0.95] and mean dmft 1.34 [±2.15]). The differences between DMFT and dmft scores in the two groups were statistically significant (P < .000 and P = .002, respectively). Conclusions: Schoolchildren of Santiago Province of 6-12 year old diagnosed with MIH had higher DMFT/dmft scores compared to schoolchildren not affected with MIH.

Family-Based Genetic Association for Molar-Incisor Hypomineralization.

Despite some evidence of genetic and environmental factors on molar-incisor hypomineralization (MIH), its aetiology remains unclear. This family-based genetic association study aimed more comprehensively to investigate the genetic carriage potentially involved in MIH development. DNA was obtained from buccal cells of 391 individuals who were birth family members of 101 Brazilian nuclear families. Sixty-three single nucleotide polymorphisms (SNPs) were investigated in 21 candidate genes related to amelogenesis using the TaqMan™ OpenArray™ Genotyping platform. All SNPs were genotyped in 165 birth family members unaffected by MIH, 96 with unknown MIH status and 130 affected individuals (50.7% with severe MIH). Association analysis was performed by the transmission/disequilibrium test (TDT), and statistical results were corrected using the false discovery rate. Significant results were obtained for SNPs rs7821494 (FAM83H gene, OR = 3.7; 95% CI = 1.75-7.78), rs34367704 (AMBN gene, OR = 2.7; 95% CI = 1.16-6.58), rs3789334 (BMP2 gene, OR = 2.9; 95% CI = 1.34-6.35), rs6099486 (BMP7 gene, OR = 2.2; 95% CI = 1.14-4.38), rs762642 (BMP4 gene, OR = 2.3; 95% CI = 1.38-3.65), rs7664896 (ENAM gene, OR = 2.1; 95% CI = 1.19-3.51), rs1711399 (MMP20 gene, OR = 0.4; 95% CI = 0.20-0.72), rs1711423 (MMP20 gene, OR = 2.1; 95% CI = 1.18-3.61), rs2278163 (DLX3 gene, OR = 2.8; 95% CI = 1.26-6.41), rs6996321 (FGFR1 gene, OR = 2.7; 95% CI = 1.20-5.88), and rs5979395 (AMELX gene, OR = 11.7; 95% CI = 1.63-84.74). Through this family-based association study, we concluded that variations in genes related to amelogenesis were associated with the susceptibility to develop MIH. This result is in agreement with the multifactorial idea of the MIH aetiology, but further studies are necessary to investigate more thoroughly the factors that could influence MIH.

Control of white spot lesion adjacent to orthodontic bracket with use of fluoride varnish or chlorhexidine gel.

The aims of this study were to compare the effectiveness of fluoride varnish and chlorhexidine gel in controlling white spot lesions (WSLs) adjacent to orthodontic brackets and to compare the ability of Quantitative Light-Induced Fluorescence (QLF) to measure mineral uptake with that of transverse microradiography (TMR). Thirty premolars with artificially induced WSLs were randomly assigned to three groups: (1) two applications of 5% NaF-varnish (F), with one-week interval, (2) two applications of 2% chlorhexidine gel (CHX), with one-week interval, and (3) control (CO), no treatment. QLF was used to measure changes in fluorescence before and after caries induction, 1 week after each application and 1, 2, and 3 months after the last application of F or CHX. TMR was performed to quantify lesion depth and mineral content after caries induction to evaluate the effects of F, CHX, and CO 3 months after the last application of agents. The data were analyzed by repeated measures ANOVA and Tukey's test. All treatments increased the mineral content during the experimental period; however, F induced faster remineralization than CHX. The correlation between QLF and TMR was significantly moderate. Two applications of fluoride varnish or 2% chlorhexidine gel at one-week intervals were effective in controlling WSLs.

Digital radiography for determination of primary tooth length: in vivo and ex vivo studies.

BACKGROUND: Methods for determining the root canal length of the primary tooth should yield accurate and reproducible results. In vitro studies show some limitations, which do not allow their findings to be directly transferred to a clinical situation. AIM: To compare the accuracy of radiographic tooth length obtained from in vivo digital radiograph with that obtained from ex vivo digital radiograph. METHOD: Direct digital radiographs of 20 upper primary incisors were performed in teeth (2/3 radicular resorption) that were radiographed by an intraoral sensor, according to the long-cone technique. Teeth were extracted, measured, and mounted in a resin block, and then radiographic template was used to standardise the sensor-target distance (30 cm). The apparent tooth length (APTL) was obtained from the computer screen by means of an electronic ruler accompanying the digital radiography software (CDR 2.0), whereas the actual tooth length (ACTL) was obtained by means of a digital calliper following extraction. Data were compared to the ACTL by variance analysis and Pearson's correlation test. RESULTS: The values for APTL obtained from in vivo radiography were slightly underestimated, whereas those values obtained from ex vivo were slightly overestimated. No significance was observed (P ≤ 0.48) between APTL and ACTL. CONCLUSION: The length of primary teeth estimated by in vivo and ex vivo comparisons using digital radiography was found to be similar to the actual tooth length.

Influence of sterilization process on cutting effectiveness andurability of ultrasonic tips / Influência do processo de esterilização na efetividade de corte e durabilidade das pontas ultra-sônicas

Objetivo: O objetivo foi avaliar a influência de diferentes métodos de esterilização na efetividade de corte e durabilidade de pontas ultra-sônicas cilíndricas comparadas com pontas diamantadas cilíndricas convencionais. Material e Métodos:Quinze pontas diamantadas cilindricas (1092)(KG Sorensen) acopladas a um motor de de alta rotação, e quinze pontas ultrassonicas cilíndricas(8,2137) (CVDentus) acopladas a um ultra-som foram utilizadas para realizar preparos cavitários padronizados em fragmentos de dentes bovinos higidos, limpos com taça de borracha, pedra-pomes e água. Após cada um dos 10 preparos, as pontas foram9 vezes esterilizadas em autoclave (SA), estufa (SO), ou limpas com escova, sabão e água (C). Os fragmentos foram pesados e microfotografias das pontas foram tomadas no início e no final do experimento. Outras9 pontas de diamante CVD e 9 convencionais foram submetidos aos mesmos ciclos de esterilização em autoclave (SAC), forno (SOC) ou lavado com água e sabão (CC) no entanto, sem serem usadas para fazer preparos cavitários, servindo como controle. Realizou-se análise descritiva dos valores encontrados na pesagem e dos scores das microfotografias.Resultados: Diferenças estatisticamente significativas(teste t de Student pareado) foram observadas entre as pontas após a esterilização (p = 0,0001). SOe SA não influenciaram na efetividade de corte e durabilidade das pontas diamantadas ultra-sônicas e convencionais. As microfotografias mostraram diferenças morfológicas entre as pontas utilizadas para os preparos e o controle. Conclusão: As esterilizaçoes por autoclave e estufa não influenciaram a efetividade de corte e durabilidade das pontas diamantadas convencionais. Pontas diamantadas convencionais apresentaram maiores alterações estruturais após a realização de preparos cavitários e procedimentos de limpeza / esterilização, independentemente do processo utilizado.

Objectives: The aim was to evaluate influence of different sterilization methods on cutting effectiveness and durability of cylindrical ultrasonic burs compared with conventional cylindrical diamond-coatedburs. Material and Methods: Fifteen conventional cylindrical diamond-coated (1092) (KG Sorensen) coupled to a high-speed turbine, and fifteen cylindrical ultrasonic (8.2137) (CVDentus) burscoupled to an ultrasound-handpiece were used toper form standardized cavity preparations in healthy bovine tooth fragments, cleaned with rubber cup, pumice stone and water. After every 10 preparations, burs were sterilized 9 times in autoclave (SA), oven (SO), or cleaned with brush, soap and water (C). Fragments were weighed and microphotographs of burs were taken at the beginning and end of experiment. Another 9 conventional diamond-coatedand 9 CVD burs under went the same sterilizationcycles in autoclave (SAC), oven (SOC) or washedwith soap and water (CC) however, without beingused for making cavity preparations, serving ascontrol. Descriptive analyses were made of thevalues found by weighing and microphotographyscores. Results: Statistically significant differences (Paired Student’s-t test) were observed among bursafter sterilization (p = 0.0001). SO and SA didnot influence cutting effectiveness and durability of ultrasonic and conventional diamond-coatedburs. The microphotographs showed morphological differences between the burs used for preparation and the control. Conclusion: Sterilization by oven andautoclave did not influence cutting effectiveness and durability of CVD and conventional diamond-coatedburs. Conventional diamond-coated burs presented greater structural alterations after performing cavity preparations and cleaning/sterilization procedures, irrespective of the process used.

Abordaje conservador y mínimamente invasivo de la Hipomineralización Molar-Incisivo (HMI) -Relato de casos clínicos / Minimally invasive treatment for esthetic management of Molar-Incisor Hypomineralization (MIH) -A case report

La Hipomineralización Molar-Incisivo (HMI) es un defecto de esmalte de origen sistèmico que afecta uno o varios molares permanentes, asociado en algunos casos a los incisivos permanentes. Defectos de esmalte, como la HMI pueden influenciar negativamente la calidad de vida, percepción estètica y autoestima de niños y adolescentes. Las opciones de tratamiento para este tipo de alteración, incluye desde medidas preventivas y procedimientos restauradores hasta la extracción dental. Factores como la edad y expectativas del paciente, severidad de la alteración y materiales deben ser considerados en el plan de tratamiento del paciente con HMI. La utilización de resinas compuestas para la restauración de molares e incisivos ha mostrado buenos resultados relacionados a la durabilidad y estètica. Este artículo presenta dos casos clínicos sobre el abordaje de la HMI en dientes anteriores, realizando preparos cavitários conservadores por medio de puntas ultrasónicas adaptadas a un sistema de ultrasonido y restauración con resina compuesta, obteniendo resultados estéticos favorables con un año de acompañamiento.

Molar-Incisor Hypomineralization (MIH) is a qualitative developmental enamel defect that affects one to four permanent first molars, with or without involvement of permanent incisors. Enamel defects may produce many symptoms that have physical, social and psychological effects and influence day-to-day living or quality of life. The available treatment modalities for teeth with MIH are extensive, ranging from prevention, restoration, to extraction. Factors such as age, patient expectations, severity of the lesion and materials should be considered in the treatment of the patient with MIH. Restoration with composite resin is an alternative choice for posterior and anterior MIH defective teeth and its use has been show acceptable results. This article describes two clinical cases involving pediatric patients with MIH whose procedure of cavity preparation was based on the use of CVD ultrasound diamond tips and restored using composite resin obtaining favorable esthetics results after a 1 year follow-up.

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation.

BACKGROUND: The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample. METHODS: One trained examiner assessed 105 occlusal surfaces by using the LF device, LF pen, FC, International Caries Detection and Assessment System (ICDAS) criteria and bitewing (BW) radiographic methods. After tooth extraction, the authors assessed the teeth histologically. They determined the optimal clinical cutoffs by means of receiver operating characteristic curve analysis. RESULTS: The specificities and sensitivities for enamel and dentin caries detection versus only dentin caries detection thresholds were 0.60 and 0.93 and 0.77 and 0.52 (ICDAS), 1.00 and 0.29 and 0.97 and 0.44 (BW radiography), 1.00 and 0.85 and 0.77 and 0.81 (LF device), 0.80 and 0.89 and 0.71 and 0.85 (LF pen) and 0.80 and 0.74 and 0.49 and 0.85 (FC), respectively. The accuracy values were higher for ICDAS, the LF device and the LF pen than they were for BW radiography and the FC. CONCLUSIONS: The clinical cutoffs for sound teeth, enamel carious lesions and dentin carious lesions were, respectively, 0 through 4, 5 through 27 and 28 through 99 (LF device); 0 through 4, 5 through 32 and 33 through 99 (LF pen); and 0 through 1.2, 1.3 and 1.4 through 5.0 (FC). The ICDAS, the LF device and the LF pen demonstrated good performance in helping detect occlusal caries in vivo. The ICDAS did not seem to perform as well at the D(3) threshold (histologic scores 3 and 4) as at the D(1) threshold (histologic scores 1-4). BW radiography and the FC had the lowest performances in helping detect lesions at the D(1) and D(3) thresholds, respectively. CLINICAL IMPLICATIONS: Occlusal caries detection should be based primarily on visual inspection. Fluorescence-based methods may be used to provide a second opinion in clinical practice.

In vitro evaluation of ICDAS and radiographic examination of occlusal surfaces and their association with treatment decisions.

This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10× occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (0­6), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and interexaminer repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was strongly associated with TD. Although the correlation between the ICDAS and BW was lower, it is still valuable in the clinical decision-making process.

Relationship between DIAGNOdent values and sealant penetration depth on occlusal fissures.

The aim of this in vitro study was to evaluate the relationship between laser fluorescence values and sealant penetration depth on occlusal fissures. One hundred and sixty-six permanent molars were selected and divided into four groups, which were each treated using a different sealant (two clear and two opaque). The teeth were independently measured twice by two experienced dentists using two laser fluorescence devices-DIAGNOdent (LF and LFpen)-before and after sealing, and then thermoclycled. After measuring, the teeth were histologically prepared and assessed for caries extension. Digital photographs of the cut sealed sites were assessed, and the sealant penetration depth was measured. All 166 sites were measured by one of the examiners taking as limits the outer and inner surface of the sealant into the fissure. For each device (LF and LFpen) and each group, the difference between the values at baseline and after sealing was plotted against the sealant penetration depth and scatter plots were provided. It could be observed that most of the points were concentrated around the zero line, for both LF and LFpen in the four groups. In conclusion, there is no relation between changes in DIAGNOdent values and increasing of depth sealant penetration within the occlusal fissures.

Influence of examiner's clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries.

The aim of this in vitro study was to assess the influence of varying examiner's clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11-0.40), B (0.12-0.33), C (0.47-0.58), and D (0.42-0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D(1) and D(3) thresholds and compared by performing McNemar test (p = 0.05). D(1) sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D(3) specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman's correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner's clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars.

The aim of this study was to compare the performance of the DIAGNOdent 2095 with visual examination for occlusal caries detection in permanent and primary molars. The sample comprised 148 permanent human molars and 179 primary human molars. The samples were measured and visually examined three times by two examiners. After measurement, the teeth were histologically prepared and assessed for caries extension. Sensitivity, specificity, accuracy and area under the receiver operating characteristics (ROC) curve were calculated. Intra-class correlation (ICC), unweighted kappa and the Bland and Altman method were used to assess inter- and intra-examiner reproducibility. DIAGNOdent showed higher specificity and lower sensitivity than did visual examination. The ICC values indicated an excellent agreement between the examinations. Kappa values varied from good to excellent for DIAGNOdent but from poor to good for visual examination. In conclusion, the DIAGNOdent may be a useful adjunct to conventional methods for occlusal caries detection.

The influence of zero-value subtraction on the performance of two laser fluorescence devices for detecting occlusal caries in vitro.

BACKGROUND: The aim of this study was to evaluate the influence of zero-value subtraction on the performance of two laser fluorescence (LF) devices developed to detect occlusal caries. METHODS: The authors selected 119 permanent molars. Two examiners assessed three areas (cuspal, middle and cervical) of both mesial and distal portions of the buccal surface and one occlusal site using an LF device and an LF pen. For each tooth, the authors subtracted the value measured in the cuspal, middle and cervical areas in the buccal surface from the value measured in the respective occlusal site. RESULTS: The authors observed differences among the readings for both devices in the cuspal, middle and cervical areas in the buccal surface as well as differences for both devices with and without the zero-value subtraction in the occlusal surface. When the authors did not perform the zero-value subtraction, they found statistically significant differences for sensitivity and accuracy for the LF device. When this was done with the LF pen, specificity increased and sensitivity decreased significantly. CONCLUSIONS: For the LF device, the zero-value subtraction decreased the sensitivity. For this reason, the authors concluded that clinicians can obtain measures with the LF device effectively without using zero-value subtraction. For the LF pen, however, the absence of the zero-value subtraction changed both the sensitivity and specificity, and so the authors concluded that clinicians should not eliminate this step from the procedure. CLINICAL IMPLICATIONS: When using the LF device, clinicians might not need to perform the zero-value subtraction; however, for the LF pen, clinicians should do so.