Prevalence and influence of dental development anomalies in smile esthetics: a cross-sectional analysis

Aim: To determine the prevalence of dental development anomalies and type of influence on the smile of adolescent students. Method: This was a cross-sectional and analytical study carried out in two public (A1) and two private (A2) schools chosen by lot in the city of Parnaíba-Piauí. The sample calculation was based on the target population: number of people enrolled in public and private schools between 15 and 19 years, in the city of Parnaíba-PI, which totaled 6209 students in 2020, according to a survey carried out by the Brazilian Institute of Geography and Statistics ­ IBGE. A questionnaire on epidemiological data and aesthetic self-perception of the smile was applied to 160 adolescents between 15 and 19 years old, from August 2020 to July 2021. The clinical examination was carried out under natural light, to check for the presence of anomaly(s) in the dental development. Students who presented only one pathology would be called group 1 (G1), those who presented two would be called group 2 (G2) and those who presented 3 or more would be called group 3 (G3). On the other hand, adolescents in whom no anomaly was evidenced would participate in the control group (CG), both in A1 and A2. Results: It was observed that 37.5% of the sample had only a type of dental anomaly, corresponding to 60 individuals. The most prevalent were enamel hypoplasia, fusion, transposition, agenesis, ectopic eruption, microdent and dens-in-dent. It was possible to verify a higher prevalence in the maxilla, private schools (76.6%) and females (86.6%). In 45% of adolescents with dental anomalies, embarrassment was observed when smiling. Conclusion: The prevalence was relatively high, highlighting the enamel hypoplasia, influencing the smile esthetics of a reasonable number of adolescents, whether for acquaintances, strangers or even for photographs

Use of Antibiotics in early Childhood and Dental Enamel Defects in 6- to 12-year-old Children in Primary Health Care / Uso de antibióticos na primeira infância e defeitos de esmalte dentário em crianças de 6 a 12 anos na Atenção Primária à Saúde

ABSTRACT Dental enamel defects (DED) are lesions that occur due several factors. Proper care is needed to promote their treatment and prevention. The aim of this study was to evaluate the occurrence of DED in permanent teeth of children who used antimicrobial drugs in the first four years of life. This is a crosssectional study carried out in a Primary Health Care (PHC) service, which included children from six to 12 years of age. DED were evaluated by oral examination, and data on the use of antimicrobials in early childhood were collected based on medical records. Data were analyzed with the chisquare test and Fisher's exact test. The sample included 144 children. In relation to DED, 50% (72) and 20.1% (29) presented opacity and hypoplasia, respectively. Amoxicillin was the most frequently prescribed drug, followed by sulfamethoxazole + trimethoprim. Among the children, 78.5% (113) were prescribed antimicrobial drugs at least once during the first 4 years of life, and 55% (79) of them presented some type of DED. There was no statistically significant association between the variables analyzed. In conclusion, there was high prevalence of children with DED, and amoxicillin was the most commonly prescribed antibiotic.

RESUMO Os defeitos do esmalte dentário (DED) são lesões que ocorrem devido a vários fatores e é necessária atenção para promover seu tratamento e prevenção. O objetivo foi avaliar a ocorrência de DED em dentes permanentes de crianças que usaram antimicrobianos nos primeiros quatro anos de vida. Tratase de um estudo transversal realizado em um serviço de Atenção Primária à Saúde (APS), que incluiu crianças de seis a 12 anos de idade. A DED foi avaliada por dados de exames bucais, e os dados sobre o uso de antimicrobiano na primeira infância foram coletados com base em prontuários médicos. A análise foi realizada com o teste do quiquadrado e o teste exato de Fisher. A amostra foi composta por 144 crianças. Em relação ao DED, 50%(72) e 20,1%(29) apresentaram opacidade e hipoplasia, respectivamente. A amoxicilina foi o medicamento prescrito com mais freqüência, seguido pelo sulfametoxazol+ trimetoprim. Entre as crianças, 78,5%(113) receberam medica mentos antimicrobianos pelo menos uma vez nos primeiros 4 anos de vida e 55%(79) deles apresentaram algum tipo de DED. Não houve associação estatisticamente significante entre as variáveis analisadas. Em conclusão, houve uma alta prevalência de crianças com DED e a amoxicilina foi o antibiótico mais comumente prescrito.

Odontodisplasia Regional y Agenesia de Premolares. Reporte de un Caso / Regional Odontodysplasia and Premolar Agenesis. Case Report

RESUMEN: La odontodisplasia regional (OR) es una alteración en el desarrollo, no hereditario y que afecta tanto la dentición temporal como la dentición definitiva. Involucra a los tejidos mesodérmicos y ectodérmicos de los dientes lo que es condescendiente con hallazgos clínicos, radiográficos e histológicos. Su etiología aun es desconocida y se presenta mayoritariamente en mujeres. Clínicamente puede afectar al maxilar, a la mandíbula o ambas arcadas pero generalmente solo se ve comprometida una ellas, principalmente el más afectado es el hueso maxilar. Radiográficamente se observa una pobre diferencia entre los tejidos del esmalte y la dentina, siendo tejidos menos radiopacos que su contraparte sana generando un aspecto descrito como "diente fantasma". Histológicamente se observan zonas hipocalcificadas del esmalte con un orden de prismas irregulares mientras que la dentina se observa con un número reducido de túbulos dentinarios y de consistencia más fibrosa en su zona coronal. El tratamiento de la OR es controversial ya que su incidencia es baja y la literatura al respecto no es clara. El objetivo de este manuscrito, fue reportar un caso de OR y revisar la literatura relacionada. Presentamos un caso de OR en una paciente de 12 años que presenta ausencia de los dientes 2.4, 2.5 y 2.6; restos radiculares y agenesia de los dientes 3.5 y 4.5. Se describirán sus aspectos clínicos, radiográficos e histológicos. Se realizó una búsqueda sistemática en las siguientes bases de datos: Clínical key, Science Direct, PubMed y SciELO.

ABSTRACT: Regional odontodysplasia (RO) is a variation in the development; it is not hereditary and it affects both deciduous and permanent dentition. It involves the mesodermal and ectodermal tissues of dental pieces, and coincides with clinical, radiographic and histological findings. Its etiology is still unknown and it reportedly occurs mostly in women. Clinically it can affect the maxilla, mandible or both arches but generally only one is compromised, mainly the maxilla which is affected the most. Radiographically there is limited difference between enamel and dentin tissue, which is less radiopaque than their healthy counterpart, generating an aspect described as "phantom tooth". Histologically hypocalcified areas of the enamel are observed with an irregular order of prisms while the dentine is observed with a reduced number of dentinal tubules and more fibrous consistency in the coronal area. RO treatment is controversial since its incidence is low and the literature on these events is not clear. The aim of this manuscript was to report a case of RO and review related literature. We present a case of RO in a 12-year-old patient who presents absence of parts 2.4.2.5 and 2.6; radicular remains and agenesis of parts 3.5 and 4.5. Its clinical, radiographic and histological aspects are described. A systematic search was carried out in the following databases: Clinical key, Science Direct, PubMed and SciELO.

Factors associated with the development of dental defects acquired in the extrauterine environment

Abstract This study aimed to analyze the association of sociodemographic, child health, healthcare service, and access indicators with developmental defects of enamel (DDE) acquired outside the uterus, based on gestational factors. A cohort of births was carried out, and 982 children aged 12 to 30 months were examined. A total of 1,500 women were followed up as of the 5th month of gestation, and the child's gestational age was evaluated at follow-up. The clinical examination was performed as recommended by the World Health Organization, and defects were classified using the modified DDE index. Six models were considered: presence of DDE (Model 1) or opacities (Model 4), number of teeth with DDE (Model 2) or opacities (Model 5), and incidence rate of DDE (Model 3) or opacities (Model 6). Associations were estimated by relative risk (RR) in Poisson regression models. In the adjusted analysis, the mother's lowest education level was associated with the highest occurrence of DDE in Models 1 (RR = 26.43; p = 0.002), 2 (RR = 9.70; p = 0.009), and 3 (RR = 5.63; p = 0.047). Breastfeeding for over 12 months (RR = 0.45; p = 0.030) and recent use of anti-infection drugs (RR = 0.20; p = 0.039) had a protective effect on DDE (Model 1). The factors associated with the highest incidence of opacities were not having health insurance (RR = 2.00; p = 0.043) (Model 5), and belonging to a family of poor social class (RR = 4.67; p = 0.007) (Model 6). Children in a situation of socioeconomic vulnerability have a higher risk of presenting extrauterine DDE. Breastfeeding was a protection factor for DDE development.

Molar incisor hypomineralization: analysis of asymmetry of lesions

Clinically, MolarIncisor Hypomineralization (MIH) lesions are not distributed symmetrically, and their severity varies even within the same arcade. Aim: To estimate the frequency of asymmetries in hypomineralized lesions on permanent molars and incisors of children with MIH. Methods: Three pediatric dentists, calibrated following the diagnostic criteria of MathuMuju and Wright (2006) (Kappa 0.87) identified presence and severity of opacities on molars and incisors of patients with MIH. Six pairs of teeth (permanent maxillary and mandibular first molars, central and lateral incisors) were evaluated in each patient. Degree of lesion severity (0­none, 1­mild, 2­moderate, 3­severe) was recorded for each tooth. For each pair containing any affected teeth, asymmetry of presence (one tooth in the pair with lesion and the other intact), asymmetry of severity (both teeth with lesions but with different degrees of severity) or symmetry of severity (both affected teeth with the same degree of severity) were evaluated. The recorded values were entered into a database to calculate percentages, 95% confidence intervals and ChiSquare test for comparisons. Results: The sample consisted of 475 of the 1032 pairs of teeth evaluated in the 172 patients included in the study, mean age 11± 2.2 years, and 50% female. Asymmetry was found for 67.5% (63.1 71.7) of the pairs of the studied teeth. There was a significant relationship between asymmetries and symmetries (p=0.038). A total 50.1% of the pairs were asymmetrical for presence of opacities. Of these, 62.2% scored severity 1 (mild). Symmetry of severity was found for 32.5% of the lesions. Among the pairs of affected teeth, the most frequently observed degrees of lesion severity were mild and moderate, with the exception of lower molars, in which 49% had severe lesions. Conclusions: In this study, MIH lesions were asymmetrical both in presence and severity for all tooth types (AU)

Clínicamente las lesiones de Hipomineralización Molar Incisiva (HMI) no tienen una distribución simétrica variando su severidad inclusive en la misma arcada. Objetivo: Estimar la frecuencia de asimetrías en lesiones de hipomineralización en molares e incisivos permanentes de niños afectados con HMI. Métodos: Tres odontopediatras calibrados (Kappa 0,87) según los criterios de diagnóstico de MathuMuju y Wright (2006), registraron presencia y severidad de opacidades en molares e incisivos de pacientes con HMI. En cada paciente se evaluaron 6 pares de piezas dentarias permanentes: primeros molares, incisivos centrales y laterales de ambos maxilares. Para cada una de las piezas se registró el grado de severidad de la lesión (0­intacto, 1­leve, 2­moderado, 3­severo). Para cada par con alguna de sus piezas afectadas, se analizó si presentaba asimetría de presencia (una pieza del par con lesión y la otra intacta), asimetría de severidad (ambas piezas con lesión pero con distinto grado de severidad) o simetría (ambas piezas afectadas con el mismo grado de severidad en la lesión). Se calcularon porcentajes, I.C. del 95% y CHI2 para las comparaciones. Resultados: La muestra quedó conformada por los 475 pares de piezas dentarias que presentaron lesión entre un total de 1032 pares de piezas analizadas en los 172 pacientes incluidos en el estudio (edad media 11 ± 2,2 años, 50% género femenino). El 67,5% (63,171,7) de los pares de piezas dentarias estudiados presentaron relación de asimetría. La relación entre frecuencia de asimetrías y simetrías fue significativa (p= 0,038). Del 50,1% de los pares que presentó asimetrías en presencia, un 62,2% mostró grado de severidad 1(leve) en una de sus piezas. Entre los pares afectados, las lesiones leves y moderadas fueron las más observadas en todos los grupos dentarios, a excepción de los molares inferiores que revelaron un 49% de lesiones severas. Conclusiones: En este estudio las lesiones de HMI presentaron, en su mayoría, algún tipo de asimetría (de presencia o de severidad) en todos los grupos dentarios (AU)

Amelogénesis imperfecta en una familia / Amelogenesis imperfecta in a family

Introducción: la amelogénesis imperfecta consiste en un grupo de desórdenes hereditarios que afectan el desarrollo del esmalte dental, de tal forma que se ve comprometida la apariencia clínica de todos o casi todos los dientes, tanto temporales como permanentes. Objetivo: informar las características y condiciones clínicas de la dentición de tres individuos de una misma familia con diagnóstico presuntivo de amelogénesis imperfecta. Presentación de casos: se realizó examen intrabucal a tres individuos con rango de consanguinidad de primer grado (madre y dos hijos) quienes presentaban alterado estructuralmente el esmalte de los dientes. De acuerdo con las características clínicas dentales y el método de Witkop, los individuos fueron diagnosticados de forma presuntiva con amelogénesis imperfecta hipomadura tipo II (madre), caracterizada por hipomaduración del esmalte y fragmentación por desgaste en los bordes incisales; amelogénesis imperfecta hipoplásica tipo I (hijo mayor), con amplias zonas de dentina expuesta opaca y con manchas pardas generalizadas; y amelogénesis imperfecta hipomadura tipo II (hijo menor), con predominio de lesiones en forma de copo de nieve o motas de algodón. Conclusiones: el diagnóstico clínico de la amelogénesis imperfecta basado en métodos fenotípicos resulta impreciso debido a la imposibilidad de establecer el origen de las alteraciones macroestructurales del esmalte. Sin embargo, de acuerdo con la descripción de los tres casos, son las afecciones en la cantidad y calidad del esmalte las que permiten realizar un diagnóstico clínico presuntivo, que guía la implementación de un tratamiento odontológico direccionado a la solución del compromiso estético y a la prevención del compromiso del órgano dentino-pulpar. En esta presentación de casos, la manifestación fenotípica de la enfermedad pasó de la madre a ambos hijos, siendo la amelogénesis imperfecta hipomadura dominante en el hijo menor(AU)

Introduction: amelogenesis imperfecta consists of a group of hereditary disorders that affect the development of the dental enamel in such a way that the clinical appearance of all or almost all primary and permanent teeth is compromised. Objective: report the clinical characteristics and conditions of the dentition of three individuals from the same family with a presumptive diagnosis of amelogenesis imperfecta. Case presentation: intraoral examination was performed of three first-degree relatives (mother and two children) with structurally altered tooth enamel. Based on their clinical dental characteristics and the results of the Witkop method, the individuals were presumptively diagnosed with hypomaturation amelogenesis imperfecta type II (mother), characterized by enamel hypomaturation and fragmentation by wear on the incisal edges; hypoplastic amelogenesis imperfecta type I (elder son), with large areas of opaque exposed dentin and generalized brown spots; and hypomaturation amelogenesis imperfecta type II (younger son), with a predominance of lesions in the shape of snowflakes or cotton wads. Conclusions: clinical diagnosis of amelogenesis imperfecta based on phenotypic methods is imprecise, since it is not possible to establish the origin of the macrostructural alterations of the enamel. However, according to the description of the three cases, quantitative and qualitative damage to the enamel makes it possible to establish a presumptive clinical diagnosis which will guide the implementation of a dental treatment aimed at resolving the aesthetic commitment and preventing involvement of the dentine-pulp complex. In this case presentation, the phenotypic manifestation of the disease passed from the mother to both children, and hypomaturation amelogenesis imperfecta was dominant in the younger son(AU)

Prevalence and factors associated with enamel defects among preschool children from a southeastern city in Brazil / Prevalência e fatores associados aos defeitos de desenvolvimento de esmalte em crianças pré-escolares de uma cidade do sudeste do Brasil

Abstract This study sought to determine the prevalence of developmental defects of enamel (DDE) among preschool children and investigate associations with sociodemographic and socioeconomic factors and weight status. A cross-sectional study was conducted with 118 children aged 3 to 5 years. Data were collected via clinical examinations and a self-administered questionnaire completed by the parents. The diagnosis of DDE was performed using the modified DDE Index. Information on socioeconomic indicators (mother's schooling, monthly income per capita), child's sex and age, and age of mother at the birth of the child were obtained by questionnaire. The children's weight status was determined based on weight-for-age at the time of the exam. Statistical analysis involved the chi-squared test and Poisson regression with robust variance. The prevalence of DDE was 50.0%. DDE were more frequent in males (p = 0.025) and children whose families were classified as being at poverty line (p = 0.040). In the Poisson model controlled for child's sex and mother's schooling, children whose families were classified as being at the poverty line had a greater prevalence rate of DDE. In conclusion, the prevalence of DDE was high in the present sample and associated with lower household income. Weight status was not associated with DDE.

Resumo Objetivou-se avaliar a prevalência de defeitos de desenvolvimento de esmalte (DDE) em pré-escolares e investigar a associação com fatores sociodemográficos e socioeconômicos e peso da criança. Foi realizado um estudo transversal com 118 crianças de três a cinco anos de idade. Os dados foram coletados por meio de exame clínico e questionário autoaplicável respondido pelos pais. Para o diagnóstico de DDE utilizou-se o Developmental Defects of Enamel Index. Informações sobre indicadores socioeconômicos (escolaridade da mãe e renda familiar per capita), gênero e idade da criança e idade da mãe ao nascimento da criança foram obtidas do questionário. O status de peso foi determinado baseando-se no peso e idade da criança no momento do exame. A análise estatística incluiu teste do qui-quadrado e regressão de Poisson. A prevalência de DDE foi 50.0%, sendo mais frequente em crianças do sexo masculino (p = 0.025) e provenientes de famílias incluídas na linha de pobreza (p = 0.040). No modelo de regressão de Poisson ajustado para gênero e escolaridade da mãe, observou-se que as crianças provenientes de famílias incluídas na linha de pobreza apresentaram maior prevalência de DDE. Conclui-se que a prevalência de DDE foi alta e associada com renda familiar per capita. O peso da criança não foi associado com DDE.

Comparative analysis of different prophylactic methods for roughness of primary tooth enamel / Análise comparativa de diferentes métodos profiláticos sobre a rugosidade do esmalte em dentes decíduos

Objective: The purpose of this study was to comparatively evaluate quantitative effects of three different prophylactic methods of surface polishing treatments for primary teeth compared to a standardized control group. Material and Methods: 48 naturally exfoliated primary teeth were selected and randomly assigned into four groups: Control Group ­ teeth receiving only enamel standardization treatment with polishing disc to reduce natural enamel; Group I ­ teeth receiving superficial enamel standardization treatment followed by polishing with a mixture of water and pumice; Group II ­ teeth receiving enamel standardization treatment followed by prophylaxis with paste (Herjos-F, Vigodent S/A Indústria e Comércio, Rio de Janeiro, Brazil); and Group III ­ teeth receiving enamel standardization treatment followed by sodium bicarbonate spray (Profi II Ceramic, Dabi Atlante Indústrias Médico-Odontológicas Ltda, Ribeirão Preto, Brazil). All the procedures were performed by the same operator and the samples were rinsed and stored in distilled water. Comparative assessment of the enamel surface roughness between experimental groups and control group was performed by using a surface profilometer (Mitutoyo SJ400). Results: The results of this study were statistically analysed by using Minitab statistical software (version 17.1.0, 2013). The use of pumice and water led to significantly rougher surfaces than in other groups (i.e. Group I: 1.22 Ra; Group II 0.38 Ra; Group III: 1.01 Ra). Conclusion: Based on this study, one can conclude that use of pumice and water resulted in increased enamel surface roughness in comparison to the surface treatment with bicarbonate spray and prophylaxis paste. (AU)

Objetivos: O objetivo deste estudo foi quantificar e comparar a rugosidade do esmalte dentário após de três diferentes tratamentos profiláticos para polimento de superfície de esmalte em dentes decíduos, em relação a um grupo controle. Material e Métodos: 48 dentes decíduos naturalmente esfoliados foram selecionados e alocados aleatoriamente em quatro grupos. Grupo Controle: recebeu apenas padronização do esmalte através do disco de polimento para redução de dentes naturais. O grupo I recebeu padronização superficial do esmalte seguido de polimento por mistura de água e pedra-pomes; o grupo II recebeu padronização do esmalte seguido da pasta de profilaxia Herjos-F (Vigodent S / A Indústria e Comércio, Rio de Janeiro, Brasil); e o grupo III recebeu padronização da superfície do esmalte seguido de spray de bicarbonato de sódio Profi II Ceramic (Dabi Atlante Indústrias Médico Odontológicas Ltda., Ribeirão Preto, Brasil). Todos os tratamentos de superfície foram realizados pelo mesmo operador, por dez segundos e as amostras foram lavadas e armazenadas em água destilada. A avaliação comparativa da rugosidade superficial do esmalte entre os grupos experimentais e controle foi realizada utilizando-se um perfilômetro de superfície Mitutoyo SJ400. Resultados: Os resultados deste estudo foram analisados estatisticamente com o software estatístico Minitab (versão 17.1.0, 2013). A pedra-pomes e a água geraram significativamente maior aspereza na superfície de esmalte, em comparação aos outros grupos, quando empregado o teste estatístico de Tukey (Grupo I: 1,22 Ra; Grupo II: 0,38 Ra; Grupo III: 1,01 Ra). Conclusão: Com base neste estudo, pode-se concluir que a pedra-pomes e a água resultaram em aumento da rugosidade superficial do esmalte em comparação ao tratamento superficial com spray de bicarbonato e pasta profilática.(AU)

Enamel defects and tooth eruption disturbances in children with sickle cell anemia

Abstract Sickle cell anemia, a genetic disease caused by a mutation in the beta-globin gene, can present oral manifestations such as delayed tooth eruption and hypomineralized enamel and dentin. The aim of the present study was to evaluate the prevalence and severity of developmental defects of enamel (DDE) and delayed tooth eruption in children with sickle cell anemia. The sample comprised 56 male and female children with sickle cell anemia aged 6 to 12 years and treated at the Hematology and Hemotherapy Center of Pernambuco, Brazil. The data were collected according to the WHO criteria for DDE and tooth eruption. The prevalence of DDE was 58.2% and increased with age, affecting 43.8% of children aged 6 to 8 years and 66.7% of those aged 10 to 12 years (p>0.05; Pearson's chi-square test). There was no significant association between DDE and sex; the most prevalent type of DDE was diffuse opacity (6.2%). Tooth eruption was delayed in 18 children (32.1%). The delay increased with age and was detected in 11.8% of children aged 6 to 8 years, in 20.0% of those aged 8 to 10 years and in 54.2% of those aged 10 to 12 years (p<0.05; Pearson's chi-square test). Delayed tooth eruption was higher in males (36.7%, p>0.05). The prevalence of DDE was high, increased with age and was similar between sexes, while delayed eruption was higher in males and showed a significant association with age.

Abordaje Terapéutico de la Hipomineralización Molar - Incisal. Revisión Narrativa / Peripheral Odontogenic Fibroma: Case Report

RESUMEN: Hipomineralización Molar-Incisal (MIH) es un trastorno del desarrollo dentario asociado a factores sistémicos, producido por una incompleta mineralización y maduración del esmalte. La prevalencia en niños, a nivel mundial, varía en la literatura entre el 2,4 % y el 40,2 %. Este trastorno que implica al menos un primer molar permanente, pudiendo también verse afectados los incisivos, dependiendo del momento, la duración, la susceptibilidad del individuo y la gravedad de la injuria prenatal, perinatal o postnatal. El esmalte presenta un grado variable de alteración en la translucidez, siendo éste de un espesor normal y de color blanco, o café-amarillo. Si bien se encuentra intacto en el momento de la erupción, puede sufrir fracturas post eruptivas debido a las fuerzas de la masticación, dejando límites definidos. Por lo general, los molares gravemente afectados son extremadamente hipersensibles, propensos a lesiones de caries de rápida progresión, y pueden ser difíciles de tratar en pacientes jóvenes. La atención debe abordar el comportamiento y la ansiedad del niño, con el objetivo de proporcionar restauraciones duraderas en condiciones libres de dolor. La ejecución de medidas preventivas individuales puede posponer el inicio del tratamiento restaurador y reducir la incomodidad del paciente a largo plazo. El diagnóstico precoz permitirá el seguimiento y la instauración de dichas medidas preventivas tan pronto las superficies afectadas sean accesibles. Pese a que los enfoques de tratamiento para MIH han comenzado a ser más claros y los avances en los materiales dentales han proporcionado soluciones clínicas en los casos que se consideraban sin posibilidad de restauración en el pasado, deben llevarse a cabo ensayos clínicos a largo plazo para facilitar aún más el manejo clínico de este cuadro.

ABSTRACT: Molar Incisor Hypomineralization (MIH) is a tooth development disorder, which is associated with systemic factors, produced by incomplete enamel mineralization and maturation below the enamel surface that is intact at the time of eruption. In literature, the prevalence in children worldwide varies between 2.4 % and 40.2 %. This disorder which involves at least one first permanent molar, and depending on duration, the child's susceptibility as well as the severity of prenatal, perinatal or postnatal insult may also compromise incisors. The defect reveals a variable degree of alteration in the translucency of the enamel, that has initially normal thickness and can be white, yellow or brown. Enamel surface may breakdown after eruption, due to masticatory forces, leaving sharp borders. Usually, severely affected molars are extremely hypersensitive, prone to rapid caries development, and can be difficult to manage in young patients. The complex care involved must address the child's behavior and anxiety, aiming to provide pain free treatment and durable restorations. Intensive individually prescribed preventive programs may postpone the onset of restorative treatment and reduce patient discomfort in the long term. Early identification of such children will allow monitoring and implementation of preventive measures as soon as affected surfaces are accessible. Although treatment approaches for MIH have become more clear, and advances in dental materials have provided clinical solutions in cases that in the past were regarded as unrestorable, long-term clinical trials should be realized to further facilitate clinical management of this dental defect.

Odontodisplasia regional: relato de caso clínico / Regional odontodysplasia: a case report

A Odontodisplasia Regional é uma anomalia dental rara, que envolve os tecidos dentários de origem ectodérmica (esmalte) e mesodérmica (dentina, polpa e cemento). O objetivo deste trabalho foi relatar um caso clínico de odontodisplasia regional em uma criança. Paciente de nove anos, sexo masculino, tendo como queixa principal a ausência de alguns dentes decíduos e a não irrupção dos dentes permanentes em determinada região da maxila. O dente 16, que havia irrompido, apresentava-se clinicamente, com um esmalte hipoplásico e hipomineralizado e uma imagem radiográfica bastante tênue, por isso sendo conhecido como "dente fantasma". Foram apresentados nesse relato, aspectos clínicos e radiográficos e destacadas as questões envolvidas na elaboração de um plano de tratamento. Há poucos estudos disponíveis sobre a odontodisplasia regional. A anamnese detalhada e o conhecimento das características clínicas e radiográficas são imprescindíveis para um correto diagnóstico.

Regional Odontodysplasia is a rare dental anomaly involving dental tissues of ectodermal (enamel) and mesodermal (dentin, pulp and cement) origin. The aim of this study was to report a case of regional odontodysplasia in a child. A nine-year-old male patient who the main complaint was the absence of some deciduous teeth and the non - eruption of permanent teeth in a specific area of the maxilla. The tooth 16, which had erupted, had hypoplastic and hypomineralized enamel, presenting a radiographic image lacking clearness, for that reason being known "ghost teeth". In this case report, clinical and radiographic aspects were presented and were highlighted the issues involved in the elaboration of a treatment plan. There are few available studies about regional odontodysplasia. The detailed anamnesis and the knowledge of the clinical and radiographic characteristics are essential for a correct diagnosis.

Pigmentações extrínsecas negras do esmalte em Odontopediatria / Pigmentos negros extrínsecos del esmalte en Odontopediatría / Extrinsic dark-pigmentation of the tooth enamel in pediatric dentistry

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente(AU)

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient(AU)

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente(AU)

Differential diagnosis of dental fluorosis made by undergraduate dental students / Diagnóstico diferencial de fluorose dentária por discentes de odontologia

ABSTRACT Objective To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment. Methods Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes. Results Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree. Conclusion Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

RESUMO Objetivo Verificar o conhecimento de discentes de um curso de graduação em Odontologia ao diagnosticar casos de fluorose dentária nos diversos graus de severidade, bem como escolher seu tratamento adequado. Métodos O levantamento dos dados foi realizado por meio um questionário semiestruturado, que abordou o conhecimento dos acadêmicos sobre as imagens de bocas contendo alterações do esmalte dentário. Resultados Apenas três imagens foram diagnosticadas corretamente pela maioria dos acadêmicos; a maior dificuldade foi o diagnóstico da severidade da fluorose dentária. Conclusão Apesar das informações sobre fluorose repassadas no decorrer do curso de Odontologia, definidas pelos conteúdos abordados na matriz curricular, expressiva parte dos alunos ainda não soube diferenciá-la de outras lesões, não demonstrando domínio sobre a severidade e as indicações de tratamento, o que indicou desconhecimento no diagnóstico correto das alterações de superfície de esmalte.

Amelogênese imperfeita: planejamento estético e previsibilidade dos resultados / Amelogenesis imperfecta: aesthetic treatment planning and predictability of results

Amelogênese imperfeita é uma doença hereditária que afeta a qualidade e a quantidade de esmalte. Os pacientes usualmente sofrem de complicações orais e estéticas que afetam diretamente sua qualidade de vida. O adequado diagnóstico e o correto planejamento são fundamentais para obter resultados previsíveis e satisfatórios. O objetivo deste artigo é apresentar um relato de caso clínico para o tratamento de uma paciente com amelogênese imperfeita (AI) em que estética e função foram reabilitadas com cirurgia plástica gengival e laminados cerâmicos...

Amelogenesis Imperfecta is a hereditary condition which affects the quality and quantity of enamel. Patients usually suffer from oral and aesthetic complications that affect directly their quality of life. Accurate diagnosis and correct planning are fundamental to obtain predictable and satisfactory results. The aim of this manuscript is to present a clinical case report for the treatment of a patient affected by amelogenesis imperfecta (AI), which aesthetics and function was rehabilitated with gingival plastic surgery and ceramic veneers...

Laminados cêramicos para reabilitação estética em dentes com amelogênese imperfeita / Ceramic laminates for aesthetic rehabilitation of teeth with amelogenesis imperfecta

Pacientes que apresentam alterações na estrutura dos elementos dentais que refletem na estética do sorriso estão em constante busca por procedimentos que reabilitem forma, função e principalmente estética. A amelogênese imperfeita é caracterizada por alterações na quantidade e/ou qualidade do esmalte dental e atinge tanto a dentição decídua quanto a permanente, interferindo na estética do sorriso. Para reabilitar pacientes com amelogênese imperfeita, diversos tratamentos estão disponíveis. Desse modo, o presente relato de caso clínico tem por finalidade demonstrar a reabilitação estética em um paciente com amelogênese imperfeita através do uso de laminados cerâmicos minimamente invasivos...

Patients presenting changes of tooth structure which impairs the aesthetics of the smile are consistently searching for procedures to restore form, function and mainly their aesthetics. Amelogenesis imperfecta is a disorder characterized by changes in the amount and/or quality of tooth enamel, affecting primary and permanent dentitions. Several treatments are available to rehabilitate patients with amelogenesis imperfecta. The aim of this case report is to demonstrate the aesthetic rehabilitation of a patient with amelogenesis imperfecta using minimally invasive porcelain laminate veneers...

Prevalência de hipomineralização molar-incisivo e fatores associados em escolares de um município do sudeste brasileiro / Prevalence of molar incisor hypomineralization and associated factors among schoolchildren from a city in southeastern Brazil

Estudos no mundo todo têm investigado os potenciais fatores envolvidos na ocorrência da hipomineralização molar-incisivo (HMI), porém os resultados relatados são variados e inconclusivos. Desta forma, os objetivos deste estudo foram verificar a prevalência de HMI em um grupo de escolares de oito e nove anos de idade e investigar os possíveis fatores associados. Um estudo transversal foi realizado com uma amostra de base populacional. A amostra aleatória, estratificada entre escolas públicas e privadas, foi composta por 1.181 escolares residentes em Lavras, Minas Gerais, Brasil. Previamente ao estudo principal, um estudo piloto foi desenvolvido para testar a metodologia. Os dados foram coletados através de exame clínico e questionários autoaplicáveis respondidos pelas mães. As mães responderam a um questionário autoaplicável contendo questões abrangendo características pré-natais, perinatais e saúde da criança nos quatro primeiros anos de vida e a outro sobre características socioeconômicas e demográficas. A HMI foi diagnosticada a partir dos critérios da Academia Europeia de Odontopediatria. Por meio do exame bucal, avaliou-se também a cárie dentária nas dentições decídua e permanente, de acordo com as recomendações da Organização Mundial de Saúde (OMS) e os defeitos de desenvolvimento de esmalte (DDE) nos segundos molares decíduos utilizando o Developmental Defects of enamel Index (DDE index). Os exames bucais foram realizados por um único examinador previamente calibrado. A análise estatística incluiu descrição dos dados, testes bivariados e modelos de regressão de Poisson com variância robusta (p<0.05, IC95%). Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (CAAE 10659812.0.0000.5149). A prevalência de HMI foi de 20,4%. Observou-se maior frequência de HMI entre as crianças com cárie na dentição permanente (RP: 2,67; IC95%: 1,98-3,61), DDE nos segundos molares decíduos (RP: 2,54; IC95%: 1,87- 3,45) e que tiveram asma e/ou bronquite até os quatro anos de idade (RP: 1,93; IC95%: 1,45-2,56). Conclui-se que a prevalência de HMI foi alta na amostra estudada. A HMI foi mais frequente em crianças com experiência de cárie na dentição permanente, com presença de DDE nos segundos molares decíduos e 10 naquelas que tiveram asma e/ou bronquite até os quatro anos de idade, mesmo após controle para os fatores potencialmente associados

Although studies worldwide have investigated potential factors involved in the occurrence of molar incisor hypomineralization (MIH), the findings are varied and inconclusive. Thus, the aim of this study was to determine the prevalence and investigate the factors associated with the occurence of molar incisor hypomineralization in a group of schoolchildren aged eight and nine years. A crosssectional study was conducted with a population-based sample. The random sample, stratified between public and private schools, consisted of 1181 children residents in Lavras, Minas Gerais, Brazil. Prior to the main study, a pilot study was carried out to test the methodology. Data were collected via clinical examination and selfadministered questionnaires completed by mothers. Mothers completed a selfadministered questionnaire with questions on prenatal, perinatal and postnatal aspects, and another questionnaire on socioeconomic and demographic aspects. MIH was diagnosed using the criteria of the European Academy of Pediatric Dentistry. During the clinical examination, the presence of caries in permanent and primary dentitions, according to the recommendations of the World Health Organization (WHO) and developmental defects of enamel (DDE) in the second primary molars using the Developmental Defects of enamel Index (DDE index) also were evaluated. Oral examinations were performed by a single examiner who had undergone a training exercise. Data analysis involved descriptive statistics, bivariate tests and Poisson regression with robust variance (p<0.05, IC95%). This study was approved by the Ethics Committee of the Federal University of Minas Gerais, Brazil (CAAE 10659812.0.0000.5149).The prevalence of MIH was 20.4%. MIH was more frequent among children with dental caries in permanent dentition (PR: 2,67; 95%CI: 1,98-3,61); those with DDE on the primary second molars (PR: 2,54; 95%CI: 1,87- 3,45) and those who experienced asthma and/or bronchitis in the first 4 years of life (PR: 1,93; 95%CI: 1,45-2,56). In conclusion, the prevalence of MIH was high in the present sample. The occurrence of MIH was more frequent in children with caries experience in the permanent dentition, those with enamel defects on primary second 12 molars and those who had asthma experience in the first four years of life, even after controlling for potential confounding factors

Síndrome amelogénesis imperfecta-nefrocalcinosis: revisión bibliográfica / Amelogenesis imperfect-nephrocalcinosis syndrome: literature review

El Síndrome Amelogénesis Imperfecta-Nefrocalcinosis es una rara enfermedad caracterizada por presentar Amelogénesis Imperfecta (AI) tipo hipoplásico en su mayoría asociado a una enfermedad renal llamada: Nefrocalcinosis.La AI es una alteración de la estructura y apariencia del esmalte con un origen genético que afecta en su mayoría a todos los dientes. Puede presentarse aislada o asociada a síndromes. Se distinguen 3 tipos (hipoplásico, hipocalcificado o hipomadurado) y entre ellos existen 15 subtipos, basado en las manifestaciones clínicas y el modo en que se transmite. Entre los genes descritos están: AMELX, ENAM, FAM83H, KLK4 y MMP20. La nefrocalcinosis (NC) es una enfermedad comúnmente caracterizada por la precipitación de sales de calcio en el tejido renal. En los pacientes con este síndrome, el daño en la función renal es variable y puede demorarse hasta la adultez a pesar de la presencia típica de hiperecogenicidad en la niñez. La relación entre los defectos de esmalte y la NC aun es incierta, pudiendo ser de tipo medular o cortical, siendo la primera la más común. El objetivo de esta revisión bibliográfica es detallar las características y tipos de ambas entidades, así como describir los casos publicados en la literatura. La mayoría de los reportes que se hacen cumplen un patrón autosómico recesivo, generalmente por matrimonios consanguíneos, donde se presenta la NC de tipo medular y la AI es de tipo hipoplásico en su mayoría, que se caracteriza por ser un defecto cuantitativo de esmalte, donde clínicamente se observa ausencia del mismo...

Amelogenesis Imperfecta -Nephrocalcinosis Syndrome is a rare disease characterized by the presence of Amelogenesis Imperfecta (AI) mostly hypoplastic type associated with a kidney disease called: Nephrocalcinosis. The AI is an alteration of the structure and appearance of the enanel with a genetic origin that mostly affects all the teeth. There may be isolated or associated with syndromes. There are 3 types (hypoplastic, hypocalcification or hypomineralised) and among them, there are 15 subtypes based on clinical manifestations and the mode how it is transmitted. Among the genes described are: AMELX, ENAM, FAM83H, KLK4 and MMP20. Nephrocalcinosis (NC) is a disease commonly characterized by the precipitation of calcium salts in the renal tissue. In patients with this syndrome, impaired renal function is variable and may be delayed until adulthood despite the presence of typical hyperechogenicity in childhood. The relationship between enamel defects and NC is still uncertain and may be cortical or medullary type, being the most common the first one. The aim of this review is to describe the characteristics and types of both entities, and to describe the cases published in the literature. Most reports have an autosomal recessive pattern, usually by consanguineous marriages, which it is presents mostly the NC medullary type and hypoplastic type of AI, which is characterized like a quantitative defect of enamel, where clinically observed absence of enamel...

Happle-Tinschert Syndrome: Report of a Case with Hemimegalencephaly

Happle-Tinschert syndrome is a disorder causing unilateral segmentally arranged basaloid follicular hamartomas of the skin associated with ipsilateral osseous, dental and cerebral abnormalities including tumors. Although a case with hemimegalencephaly was previously described, this is the first report of Happle-Tinschert syndrome with discrepant short left leg, ipsilateral skin lesions, hemimegalencephaly and frontal polymicrogyria.

Perinatal factors associated with developmental defects of enamel in primary teeth: a case-control study

The present study was designed to evaluate associations between developmental defects of enamel (DDE) in the primary dentition and aspects related to mothers and preschoolers in the city of Diamantina, Brazil. A case-control study was carried out involving children aged three to five years. The case group was composed of 104 children with at least one dental surface affected by DDE. The control group comprised 105 children without DDE, matched for gender and age. The diagnosis of enamel defects was performed using the Developmental Defects of Enamel Index. Information was collected through interviews investigating socio-demographic aspects, gestation, birth weight, prematurity and breastfeeding. Simple and multiple regression analyses were performed, providing unadjusted and adjusted prevalence ratios (Poisson regression). DDE were more prevalent among children who had not been breastfed (PR = 1.57; 95% CI: 1.1-2.2) and those whose mothers were under 24 years of age at the birth of the child (PR = 1.41; 95% CI: 1.1-1.9). The prevalence of DDE in the primary dentition was higher among children who had not been breastfed and those whose mothers were under 24 years of age at the birth of the child.

Oral aspects of chronic renal failure

Diseases such as diabetes mellitus, hypertension, chronic glomerulonephritis, uropathy and autoimmune diseases are considered the most frequent causes of renal failure. The aim of this study was to investigate oral manifestations caused by chronic renal failure. Oral manifestations of chronic renal failure include dysgeusia, stomatitis, decreased salivary flow rate, xerostomia and parotitis; moreover, dental oriented conditions include narrowing of pulp chamber, enamel abnormalities, tooth loss and periodontal disease. The most frequent dilemma in patients with Kidney failure is Renal Osteodystrophy. Chronic renal failure could be treated by renal replacement therapy, hemodialysis and peritoneal dialysis. These are methods of removing nitrogenous and other toxic byproducts of metabolized blood. Oral maladies due chronic renal failure occur because of immunosuppressive medications. However, this kind of therapy could be challenging as it causes gingival inflammation due to increased plaque deposition; which in turn affects the periodontal tissues. A good oral hygiene may reduce the risk of oral infections in chronic renal failure patients. The awareness about kidney related diseases is often neglected; however, the number of patients with oral manifestations related to chronic renal failure is miraculous