YouTubeTM as a Tool to Teach Dentists about Molar Incisor Hypomineralization (MIH): Analysis of Quality Content

ABSTRACT Objective: To evaluate the quality of information about Molar incisor Hypomineralization (MIH) on YouTubeTM. Material and Methods: Only videos in Portuguese aimed at dentists were included. The selected videos were analyzed by two calibrated evaluators, who extracted the information (classification, etiology, diagnosis, and treatment of MIH) and the quality was evaluated through a 20-point-checklist, according to the International Association of Pediatric Dentistry and European Academy of Pediatric Dentistry. Descriptive analysis and statistical tests were applied to assess the association (ANOVA and Kruskal-Wallis) or correlation (Spearman) between the final scores of the videos and their demographics. Results: Nineteen videos with 13.8±4.76 mean points were considered eligible. Most of the videos did not report the possible involvement of other groups of teeth (n=12), presence of atypical restorations (n=8) and hypersensitivity (n=7); and the different treatments for MIH were very variable. Twelve videos discussed differential diagnosis and 78.95% possible etiological factors; however, all of them presented clinical images. Data related to the video source and viewer interaction were not related to its quality (p>0.05). The number of likes (r=0.26), views (r=0.34) and video time (=0.58) show a weak and moderate correlation, respectively, with video score. Conclusion: Videos on YouTubeTM about MIH presented moderate or high quality, with heterogeneous information, and can act as a complementary aid source of information.

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.

Aesthetic perceptions and social judgments about different enamel opacities.

This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Aesthetic perceptions and social judgments about different enamel opacities

Abstract This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Defining the Prevalence of Molar Incisor Hypomineralization in Brazil

Abstract Objective: To define the prevalence of Molar Incisor Hypomineralization (MIH) in Brazil since the reports ranged from 2.5% to 40.2%. Material and Methods: We studied 407 children from 7 to 14 years of age. MIH was measured using the European Academy of Paediatric Dentistry criteria of 2003. Clinical data were collected by a calibrated dentist (Kappa=0.88) and included affected teeth and degree of MIH severity (mild/severe). Mild MIH cases were considered when the tooth presented demarcated opacity ≥ 1.0mm, without any loss of structure. While severe cases were defined by teeth in which loss of structure was present, or past or current lesion that required treatment, or presence of atypical restorations. In addition, published data (nine studies) reporting MIH in Brazilians were identified, and the heterogeneity of these studies was tested (I2 index/ p≤0.01). Results: In the original sample studied, the majority of patients were males (55.3%; n = 225), with an average age of 10.1 years (± 2.1 years). The prevalence of MIH in this group was 14.5% (59 affected in 407), and most of the affected teeth had a mild degree of alteration (77.4% or 202 in 261 teeth). Conclusion: A meta-analysis including nine published reports, and our original data showed that MIH prevalence in Brazil is 13.48 (95% CI, 8.66% -18.31%).

Fatores ambientais e variações genéticas nos genes AMBN, ENAM, KLK4, IRF6, TFGα em pacientes com hipomineralização molar incisivo / Environmental factors and genetic variations in the AMBN, ENAM, KLK4, IRF6, TFGα in patients with incisor molar hypomineralization

Trata-se de uma tese composta por quatro estudos, com o objetivo de avaliar possíveis fatores etiológicos (ambientais e genéticos) associados a presença de Hipomineralização Molar Incisivo (HMI) através de (a) : um estudo observacional transversal para verificar a prevalência de HMI na amostra estudada, junto com uma revisão bibliográfica da prevalência desta condição na população brasileira (objetivo-I); associação de fatores ambientais (durante o período gestacional e nos primeiros anos de vida) relacionados à presença de HMI e a influência destes fatores com a gravidade dessa condição (objetivo-II); associação dos polimorfismos de único nucletídeo (SNPs) localizados nos genes ameloblastina (AMBN), enamelina (ENAM) e calecreína com HMI, além da possível susceptibilidade dos SNPS com à cárie dentária (objetivo-III) e a interação entre fatores ambientais e as variações genéticas nos SNPs localizados nos genes fator 6 regulator de interferon (IRF6) e fator de crescimento transformador alfa (TGFα) estudados em amostras no Rio de Janeiro, Curitiba e turca (Istambul) (objetivo-IV). As coletas de dados do presente estudo foram realizadas em duas etapas: clínica e laboratorial. Os resultados encontrados foram: (I) uma alta heterogeneidade entre os estudos (Q = 52,81, p < 0.01, I2 = 98) com a prevalência final de HMI de 13.48% na população barasileira; (II) as intercorrências na gestação e o uso de medicamentos na primeira infância tiveram uma associação significativa com a presença de HMI (OR = 3,01; 95% CI = 1,74- 8,42; p= 0,014; OR = 3,55; 95% CI = 1,35-10,57; p = 0,019 ), entretanto esses fatores não influenciaram a gravidade dessa condição (p>0,05); (III) houve um resultado significativo no SNP rs2235091 localizado no gene KLK4 com a HMI (p<0,001), e os polimorfismos rs4694075 (AMBN) e rs3796704 (ENAM) mostraram associação com a cárie dentária (p<0.05); (IV) a amostra do Rio de Janeiro apresentou uma interação entre os SNPs rs1523305 (TGFα) e rs642961 (IRF6) (p = 0,03) e entre rs2073487 (IRF6) e rs2902345 (TGFα) (p = 0,04). Além disso, no estudo de Istambul houve uma associação entre o SNP rs930655 (TGFα) com todos os marcadores do gene IRF6 (p<0,05). Em relação ao uso de medicamentos nos primeiros anos de vida houve uma associação com os genes TGFα e IRF6 nas amostras de Curitiba e do Rio de Janeiro (p<0,05). Conclui-se que; (I) a prevalência de HMI é de 13.48% na população brasileira; (II) existe uma relação entre a presença de HMI com complicações que ocorrem durante a gestação (uso de medicamentos) e nos primeiros anos de vida da criança, entretanto esse fatores não influenciaram na gravidade dessa condição; (III) os genes que atuam na formação do esmalte são capazes de influenciar tanto no desenvolvimento da HMI como podem estar associados à cárie dentária e (IV) os polimorfismos localizados nos genes IRF6 e TGFα estão relacionados com o desenvolvimento da HMI. Além disso, o uso de medicamentos nos primeiros anos de vida podem potencializar o desenvolvimento da HMI. (AU)

It is a thesis composed of four studies, with the main to evaluate possible etiological factors (environmental and genetic variation) associated with the presence of MIH in the Brazilian population through (e); (objective-I); a cross-sectional observational study, with a bibliographic review of the prevalence of MIH in Brazil (objective-I); to determine of environmental factors (during in the pregany period and childhood) associated with the presence of MIH, and to evaluate the influence of these factors with the MIH severity (objective-II); associations of single nucleotide polymorphism (SNPs) presentin the genes ameloblastin (AMBN), enamelin (ENAM) and kalekrein (KLK-4) with MIH, in addition to the possible susceptibility of this genes to dental caries (objective-III); and interaction of environmetal factors and to determine the influence of genes interferon regulatory factor 6 (IRF6) and transforming growth factor alpha (TGFα) with MIH in a Brazilian (Rio de Janeiro e Curitiba) and Turkish (Istanbul) population (objective-IV). Data collections of the present study were carried out in two stages: clinical and laboratory.The results found were: (I) a high heterogeneity among the studies (Q = 52.81, p<0.01, I2 = 98) with a final prevalence of 13.48% na Brazilian population; (II) an association between intercurrences during pregnancy and child taking medications with the presence of MIH (OR = 3.55; 95% C.I = 1.35-10.57, p= 0.014; OR = 3.01; 95% C.I = 1.74- 8.42, p= 0.019, respectively), however these factors did not influence the severity of MIH (p>0.05); (III) there was an association between the variant alleles of polymorphisms rs2235091 in the KLK4 gene (p≤0.01) with the presence of MIH and the SNPs rs4694075 in AMBN and rs3796704 in ENAM presents association with dental caries (p<0.05); (IV) that the study from Rio de Janeiro showed a statistical evidence of interaction between TGFA rs1523305 and IRF6 rs642961 (p=0.03) and between genes IRF6 rs2073487 and TGFA rs2902345 (p=0.04). Significant results were found for the study from Istanbul between TGFα rs930655 and all IRF6 markers (p<0.05). Also, there was found statistical evidence for interaction of the SNPs in IRF6 and TGFα genes and medication taking from Curitiba and Rio de Janeiro studies (p<0.05). In summary; (I) the prevalence of MIH is 13.48% in the Brazilian population; (II) there is a relationship between complication that occur during pregnancy and in the child's first years of life with the presence of MIH, however these factors do not influence the severity of this condition; (III) the genes that acting in the enamel formation may influence the development of MIH and them, may be associated with dental caries; (IV) the polymorphisms located in the IRF6 and TGFα genes play a role in the development of MIH in different populations and that these genes may interacting with the medication taken in the first years of life, pontecialising the presence of MIH. (AU)

Hipomineralização molar- incisivo: percepção estética de crianças/adolescentes e de seus responsáveis / Molar-incisive hypomineralization: aesthetic perception of children / adolescents and their caregivers

O objetivo do presente trabalho foi avaliar a percepção estética de pacientes com hipomineralização molar-incisivo (HMI) e de seus responsáveis, bem como verificar o possível impacto da HMI em sua condição psicossocial antes e depois de seu tratamento. Além disso, verificou-se também uma possível correlação entre cárie dentária e HMI. Para este fim, foram avaliadas 56 crianças/adolescentes com idades entre 7 e 14 anos, divididas em dois grupos: grupo caso (crianças portadoras de HMI n=28) e grupo controle (crianças sem HMI n=28), além de seus responsáveis. Os critérios de exclusão foram ausência de curso de alfabetização, pacientes com comprometimento sistêmico e/ou cognitivo, com história de trauma dentário e aqueles em tratamento ortodôntico. A coleta de dados foi realizada por um único examinador treinado e calibrado (teste Kappa=0,88) através de exame clínico e aplicação de questionários. Na avaliação da percepção estética foi utilizado o questionário The Child and Parent's Questionnaire of Teeth Appearance devidamente validado e adaptado ao contexto brasileiro. Esse instrumento compreende questões de ordem física, psicológica e social, além das percepções sobre aparência (manchamento, cor, condição, alinhamento e saúde dos dentes). As opções de resposta foram em forma de múltipla escolha, apresentadas por uma escala de graduação variando da melhor condição (0) a pior condição (4). Além disso, os responsáveis responderam a um questionário semi-estruturado contendo dados pessoais, renda familiar e o nível de escolaridade dos pais. Para o diagnóstico do grau de severidade de HMI foi utilizado o critério da EADP (European Academic of Paediatric Dentistry) (graus leve e severo). O índice utilizado para a experiência de cárie dentária foi o CPO-D (dente cariado, perdido e obturado). Foram aplicados os testes do Quiquadrado, o teste T- student, regressão logística e teste Correlação de Spearman com o nível de significância de 5%. O gênero predominante nos pacientes foi o masculino (n = 35; 62,5%) e nos responsáveis, o feminino (n = 49; 87,5%). O nível sócio econômico, sexo e etnia não foram associados à HMI (p=0,77, p=0,41 p= 1,0, respectivamente). Em relação à severidade da HMI, 64,3% (n= 18) das crianças apresentaram grau leve. As crianças com HMI apresentaram uma insatisfação com as manchas em seus dentes (p=0,01). Porém não houve uma diferença estatisticamente significativa nas ordens física, psicológica e social (p = 0,17) entre as crianças. A HMI foi percebida pelos responsáveis (25,07 ±3,72), impactando sua condição psicossocial (p=0,03). Após o tratamento da HMI, houve uma melhora na percepção estética nas crianças (1,29±0,43) e nos seus responsáveis (2,43±1,0). Não houve correlação entre o CPOD e a HMI (p = 0,80). Conclui-se que a HMI foi percebida por crianças e responsáveis, impactando principalmente os responsáveis em relação às características físicas, psicológicas e sociais. O tratamento da HMI foi percebido por ambos, crianças e seus responsáveis, melhorando sua condição psicossocial. Não houve correlação entre a experiência de carie e HMI (AU)

The aim of the study was to determine patients and parent's aesthetic perception and psychological impact of molar incisor hypomineralization (MIH) before and after dental treatment. In addition, MIH was correlated with caries experience. The sample comprised 56 patients between 7 to 14 years old presenting MIH (case group) and without sing of MIH (control group), together with their parents. The exclusion criteria applied for both groups were illiterate patients and parents, patients with systemic involvement, dental trauma and under orthodontic treatment. Data collection was performed by a single calibrated examiner (Kappa test = 0.88) by clinical examination and questionnaires. The perception data used the Child and Parent's Questionnaire of Teeth Appearance. This instrument was validated and adapted to the Brazilian context and comprised questions about physical, psychological, and social conditions as well as the aspects of appearance, alignment and oral health. Answers could be given in the form of multiple choices presented on a grading scale, ranging from best condition (0) to worst condition (4). Besides, parents answered a semi-structured questionnaire containing personal data, family income, and parents' education. MIH was diagnosed by criteria of EAPD (European Academy of Pediatric Dentistry). Caries experience was assessed by DMFT (decayed, missed, filled, teeth). Chi-square, Student t and correlation tests and Binary logistic regression, were used with a significance level of 5%. The predominant gender in patients was male (n = 35; 62.5%) and most of parents were female (n = 49; 87.5%). The socioeconomic level, gender and ethnicity were not associated with MIH (p = 0.77, p = 0.41 p = 1.0, respectively). Regarding the severity of the MIH, 64.3% (n = 18) of the children had mild cases. There was no statistically significant difference in the physical, psychological and social orders (p = 0.17) in children. The MIH was perceived by parents (25.07 ± 3.72), impacting their psychosocial condition (p = 0.03). After treatment of the MIH, there was an improvement in the aesthetic perception of children (1.29±0.43) and their parents (2.43±1.0). Caries experience was not correlated to MIH (p= 0.80). We conclude that MIH was perceived by children and parents, impacting parents with regards to the physical, psychological and social aspects. The treatment of MIH was perceived by both children and their parents, improving their psychosocial condition. Caries was not correlated with MIH in this population (AU)