An Exploration of Mineral Density, Elemental and Chemical Composition of Primary Teeth in Relation to Cord-Blood Vitamin D, Using Laboratory Analysis Techniques.

Postnatally, severe vitamin D deficiency commonly results in rickets as well as potential defects in tooth mineralization. The effects of milder deficiency on oral health outcomes later in life are still unclear. This study used micro-computed tomography (µCT), energy dispersive X-ray analysis (EDX), and Raman spectroscopy to investigate mineral density, total density, and elemental composition of enamel and dentine in 63 exfoliated primary incisors from participants with known 25-hydroxyvitamin D levels (25-OHD) at birth. No differences in mineralization and chemical composition using µCT and EDX analysis were observed irrespective of 25-OHD status. Subtle structural differences were observed via Raman spectroscopy, with more crystalline enamel observed in those with sufficient 25-OHD at birth. Although subtle, the differences seen suggest further attention should be given to children with known milder levels of vitamin D deficiency in early life. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Dental Consequences of Vitamin D Deficiency during Pregnancy and Early Infancy-An Observational Study.

Vitamin D (25OHD) status during pregnancy is closely correlated with foetal and new-born 25OHD. Calcification for primary teeth begins from the fourth month of intrauterine life and from birth for permanent teeth. Dental consequences of severe 25OHD deficiency are well documented; however, consequences are less documented for milder degrees of 25OHD deficiency. This study examined the dental consequences of vitamin D deficiency/insufficiency during gestation and infancy in a cohort of 81 New Zealand children. Pregnancy and birth data for the children and their mothers and 25OHD status during gestation, birth and at five months were obtained, and dental examinations were conducted. Associations between 25OHD and enamel defects or caries experience were investigated. Of the 81 children, 55% had experienced dental caries and 64% had at least one enamel defect present. Vitamin D insufficiency (25OHD < 50 nmol/L) at all timepoints was not associated with enamel defect prevalence, but during third trimester pregnancy it was associated with an increased caries risk IRR of 3.55 (CI 1.15-10.92) by age 6. In conclusion, maternal 25OHD insufficiency during the third trimester of pregnancy was associated with greater caries experience in primary dentition. No association was found between early life 25OHD and enamel defect prevalence or severity.

Community water fluoridation: attitudes and opinions from the New Zealand Oral Health Survey.

OBJECTIVE: To report the responses of adult participants in the 2009 New Zealand Oral Health Survey (NZOHS) to questions about community water fluoridation (CWF). METHODS: The study used quantitative data from the NZOHS. All adult participants aged 18 years and over in the nationally representative NZOHS sample were included in the study (n=3475). Univariate analysis and multinominal logistic regression models were used to examine the associations between variables. RESULTS: Overall, 57.7% of respondents thought that there were dental benefits to adding fluoride to drinking water and 31.7% responded that they did not know. More than 45% of respondents did not know whether there were health risks from adding fluoride to drinking water. Overall, 42.0% of respondents were strongly or somewhat in favour of CWF. CONCLUSION AND IMPLICATIONS: People in the Maori, Pacific and Asian ethnic groups, from the two most deprived quintiles, with no education after high school and who brushed their teeth less than twice a day expressed significantly greater uncertainty about CWF than other population groups. This study suggests further research is required to gain a greater understanding of health literacy about CWF and the cultural appropriateness of CWF in NZ.

Potentially preventable admissions to New Zealand public hospitals for dental care: a 20-year review.

OBJECTIVE: To describe the prevalence of admissions to New Zealand public hospitals for dental care and associated time trends for people of all ages during the 20-year period 1990-2009. METHODS: The New Zealand Ministry of Health National Minimum Data Set (NMDS), a collection that covers all publicly funded hospital discharges, was the primary data source for this study. Data over a 20-year period from 1 January 1990 to 31 December 2009 were included, and a subset of ICD 10 codes (K02-K09 and K12 and K13) were selected to identify potentially preventable or ambulatory care sensitive conditions (ACSC) leading to admission to hospital. Volumes, proportions and rates of admission are presented to describe the patterns of admission to hospital. RESULTS: There were 120,046 admissions to public hospitals in New Zealand between 1990 and 2009 for which the provision of dental care was the primary reason for admission. The rate of admission to hospital for dental care increased from 0.92 per 1000 population in the period 1990-1994 to 2.15 per 1000 population in 2005-2009. Dental admission rates were greatest in the 3- to 4-year-old age group, for Maori and Pacific people and for people in the most deprived quintile of the NZDep 2006 index. Almost one-third of people aged 18-34 years who were admitted to hospital primarily for dental care were acute admissions. CONCLUSION: Both the volume and the rate of admission to New Zealand public hospitals for dental care have increased over the period of this study. A continued focus on strategies to reduce the impact of dental disease, particularly in the early childhood population and on ensuring accessible primary dental care for the adult population, is required.

Teething signs and symptoms: persisting misconceptions among health professionals in New Zealand.

OBJECTIVES: To investigate current beliefs and treatment recommendations for teething symptoms among health professionals in New Zealand. DESIGN: Cross-sectional survey of seven groups of health professionals. METHOD: A written questionnaire was mailed in March 2011 to 336 health professionals practising in Wellington City, Hutt Valley and Kapiti Coast, in New Zealand. The self-administered questionnaire sought information on how many children are perceived to experience teething symptoms, what symptoms are attributed to teething, suggested treatments for teething symptoms, and how distressing teething is to children and parents. RESULTS: The response rate to the single-wave survey was 41%. Although the beliefs varied widely across the groups, almost half (48%) of health professionals believed that some children have teething-associated problems, and 32% believed that most children do. Just over one-third of participants incorrectly attributed fever to teething. Health professionals also incorrectly chose nappy rash (31%), loose stools (27%), runny nose (19%) and mouth ulcers (15%) as teething signs or symptoms. Most participants (65%) suggested paracetamol as a treatment for teething; 60% chose teething gels and 48% suggested teething toys or rings. Most respondents believed that teething is moderately distressing to both the child and parent. CONCLUSIONS: The findings show that misconceptions about the symptoms of teething are held by some health professionals. Many believe that teething causes a variety of serious and systemic symptoms. The study has also shown that teething beliefs vary greatly across the different health professions.

Further examination of the prevalence of MIH in the Wellington region.

OBJECTIVES: The aim of this study was to further investigate the prevalence of Molar Incisor Hypomineralisation (MIH) in the Wellington region, in order to expand on the findings of a recent study. DESIGN: A survey of MIH in a sample of 7-to-10-year-old children attending primary school in Central Wellington, together with data from a similar survey conducted earlier in Wainuiomata. METHOD: Using the modified Developmental Defects of Enamel index, a single paediatric dentist examined students in the classroom. Any visible occurrences of demarcated opacities, post-eruptive breakdown of enamel and hypoplasia were recorded, along with dental caries experience in primary and permanent teeth. The data were combined with those from the previous study, and statistical analysis was undertaken using the combined data-set. RESULTS: In the Central Wellington study, examinations were conducted on 235 children (participation rate 58.8%, mean age 8.2 years). MIH prevalence was 18.8%. Demarcated opacities and post-eruptive breakdown affected 23.9% and 8.1% (respectively) of the sample. Pooling the data from Central Wellington and Wainuiomata gave a total sample of 756 (mean age 8.2), among which MIH prevalence was 15.7%. Demarcated opacities and post-eruptive breakdown (of any tooth) affected 18.0% and 4.6%, respectively. Hypoplasia of any tooth was observed in 0.7% of the pooled sample. There was no statistically significant association between MIH and either ethnicity or school decile. Although MIH prevalence was 3.9 percentage points higher in the Central Wellington schools than in Wainuiomata, socioeconomic status (measured through school decile) was not significantly associated with MIH. The presence of developmental defects of enamel was associated with greater caries experience in the permanent dentition. CONCLUSIONS: In the Wellington schools involved in the study, approximately one in six 7-10-year-old children had MIH. Neither school decile nor ethnicity were modifying factors in the occurrence of MIH.

The prevalence of Molar-Incisor Hypomineralisation (MIH) in Wainuiomata children.

OBJECTIVES: The aim of this study was to determine the prevalence of Molar-Incisor Hypomineralisation (MIH) in Wainuiomata children and describe differences in prevalence among Maori, Pacific Island and New Zealand European ethnic groups. DESIGN: Cross-sectional survey of developmental defects of enamel in a random sample of children attending primary school in Wainuiomata, Wellington. METHOD: Study information and consent forms were sent to 850 7-to-10-year-old schoolchildren. Using the modified Developmental Defects of Enamel index, a single paediatric dentist examined students in the classroom. Dental caries experience was recorded as decayed, missing or filled primary and permanent teeth. RESULTS: Examinations were conducted on 522 children (participation rate 61.4%). The mean age of the children was 8.2 years (range 7 to 10 years). MIH prevalence was 14.9%. The prevalence ofhypomineralisation ofany tooth was 15.3%, and that for hypoplasia was 4.0%. There was no statistically significant ethnic difference in MIH prevalence. The mean DMFT was 0.16 (SD, 0.54) in those without a developmental defect, 0.54 (SD, 1.12) in those with hypomineralisation and 1.85 (SD, 1.85) in those with hypoplasia (p < 0.01). CONCLUSIONS: Approximately one in seven Wainuiomata children have MIH. Ethnicity is not a modifying factor in the occurrence of developmental defects of enamel. The presence of hypomineralisation and/or hypoplasia was associated with significantly greater caries experience in the permanent dentition.

Dental erosion: part 2. The management of dental erosion.

Dental erosion is an important cause of tooth tissue loss in both children and adults. An earlier article (Mahoney and Kilpatrick, 2003) discussed the prevalence and causes of dental erosion. This second article will discuss the management of this condition which is often complicated by the multifactorial nature of tooth wear. Management of dental erosion can be considered in three phases: immediate, interim and long-term. Immediate management includes the early diagnosis of dental erosion, recording the status of the disorder at baseline and implementing appropriate preventive strategies including those aimed at reducing the acidic exposure as well as those that attempt to increase an individual's resistance to erosive tooth tissue loss. Interim and long-term treatment includes the provision of temporary diagnostic restorations, ongoing monitoring of disease progression, definitive restorative work where appropriate, and modification and reinforcement of preventive advice. Each phase will be discussed in light of current evidence.

Mechanical properties and microstructure of hypomineralised enamel of permanent teeth.

Isolated enamel defects are commonly seen in first permanent molar teeth but there has been little work on the physical and morphological composition of affected molars. The aim of this study was to determine the mechanical and morphological properties of hypomineralised first permanent molar teeth, utilising the Ultra-Micro-Indentation System (UMIS) and scanning electron microscope, respectively. Further investigations using Energy Dispersive X-ray Spectrometery (EDS), Back Scatter Electron (BSE) Imaging, and X-ray diffraction were employed to attempt to determine the chemical composition, mineral content and crystalline structure of the hypomineralised tissue, respectively, of eight first permanent molars with severe enamel hypomineralisation. The hardness and modulus of elasticity were found to be statistically significantly lower (0.53+/-0.31 and 14.49+/-7.56 GPa, respectively) than normal enamel (3.66+/-0.75 and 75.57+/-9.98 GPa, respectively). Although the fractured surface of the hypomineralised enamel was significantly more disorganised and the relative mineral content was reduced by approximately 5% in comparison to sound enamel, the mineral phase and Ca/P ratio was similar in hypomineralised and sound enamel. The dramatic reduction in the mechanical properties of first permanent molar teeth has ramifications when clinicians are choosing restorative materials to restore the defects. The reason for the dramatic reduction in mechanical properties of hypomineralised first permanent molar teeth is at present unknown.

Restoring proximal lesions in the primary dentition: is glass ionomer cement the material of choice?

Adhesive dental materials are now routinely used in paediatric dentistry to restore the proximal lesion. One of these materials, glass ionomer cement (GIC), has a number of advantages including ease of use, the release of fluoride, and acceptable aesthetics. These properties have led to GIC becoming one of the most widely used materials in Australasia in the paediatric population. Although there are a number of advantages for the use of GIC in the primary dentition the drive towards evidence based dentistry requires us to ask the question--is GIC the material of choice for class II restorations in primary molars? This article describes the advantages and disadvantages in the use of the different types of GIC in the primary dentition and compares its success in this group with other dental materials commonly used in class II restorations.

Dental erosion: part 1. Aetiology and prevalence of dental erosion.

Non-carious tooth tissue loss due to abrasion, attrition, abfraction and erosion has become a significant problem, occurring in up to 80 percent of children and in up to 43 percent of adults. Dental erosion is now recognised as an important cause of tooth tissue loss in both children and adults. It is caused by the presence of intrinsic or extrinsic acid of non-bacterial origin in the mouth. Intrinsic sources of acid include vomiting, regurgitation, gastro-oesophageal reflux or rumination. Extrinsic sources of acid are most commonly dietary acids. Medications, a patient's lifestyle choices and environment can also increase the risk of dental erosion. In this article we identify the prevalence of dental erosion and its main causative factors, and in Part II we will discuss the management of dental erosion.