Prevalence of Dental Fear and its Association with Painful Oral Conditions in Adolescents

ABSTRACT Objective: To estimate the prevalence of dental fear and evaluate its association with dental caries and with Molar Incisor Hypomineralization (MIH) in schoolchildren aged 11-14 years. Material and Methods: A cross-sectional study was conducted with 375 adolescents in Campina Grande, Brazil. Socioeconomic and oral health information was collected, while dental fear was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The diagnosis of dental caries and MIH was performed by three trained examiners (κ ≥ 0.61) using the International Caries Detection & Assessment System - ICDAS II and a previously validated index, respectively. Data were descriptively analyzed using the Chi-Square, Fisher's Exact, and Poisson regression tests with robust variance (p<0.05). Results: The prevalence of dental fear was 18.4%, and the mean CFSS-DS total score was 28.96 ± 8.92. After adjusting for covariates family structure, schooling of parents/guardians, type of dental health service and dental pain in the last six months, the prevalence of dental fear was associated with dental pain in the last six months (PR=2.03; 95%CI=1.31-3.16; p=0.002). Conclusion: Although no association was found between dental fear, dental caries and MIH in adolescents, those who experienced dental pain in the last six months had a higher prevalence of dental fear.

Prevalence and predisponent factors of molar-incisor hypomineralization in primary dentition

Aim: To evaluate the prevalence and predisposing factors for hypomineralization of second molars in children in primary dentition. Methods: A questionnaire was applied to parents to analyze predisposing factors and to assist in the diagnosis of hypomineralization in children between 2 and 6 years old, followed by an intraoral examination based on indices of non-fluorotic enamel defects in the primary dentition, according to the "Modified Index DDE" to determine demarcated opacity and HSPM presence / severity index to assess hypomineralization. Children from public and private schools were dived into two groups: if they presented HSPM-Group 1 (G1) and if they did not have HSPM-Control group (CG). Results: The most frequent predisposing factors associated with the child were Illness in the first year of life (X2= 6.49; p=0.01) and antibiotic use in the first year of life (X2= 41.82; p= 0.01). The factors associated with the mother were hypertension (X2= 9.36; p=0.01), infections during pregnancy (X2=14.80; p=0.01) and alcohol consumption during pregnancy (X2=97.33; p=0.01). There was a prevalence of 3.9% of HSPM in 14 children, with statistical difference regarding gender (X2 = 4.57; p <0.05), with boys presenting a higher frequency. In G1 hypomineralization was of the type with demarcated opacity, with more prevalent characteristics the yellowish spot, with moderate post-eruptive fracture and acceptable atypical restorations. All lesions were located in the labial region with 1/3 of extension. Conclusion: The prevalence of HSPM in children between 2 and 6 years old was 3.9%, with a predominance in males, with tooth 65 being the most affected. There was an association between HSPM and infection in the first year of life, as well as the use of antibiotics and sensitivity in the teeth affected by the lesion. There was an association between HSPM and hypertension, infection and mothers' alcohol use during pregnancy

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Abstract Objective: This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren. Methodology: Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis. Results: The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth. Conclusions: No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

Abstract This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.

Inheritance pattern of molar-incisor hypomineralization

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

Association between demarcated enamel hypomineralization on second primary molars and dental caries in childhood / Associações entre hipomineralização demarcada de esmante nos segundos molares decíduos e cárie dentària na infância

ABSTRACT Hypomineralized Second Primary Molars (HSPM) is the name used to describe the presence of demarcated enamel hypomineralization in second primary molars. HSPM has been compared with Molar Incisor Hypomineralization (MIH) as regards its clinical appearance and consequences. The aim of this study was to investigate associations between HSPM and dental caries in childhood. It was a cross-sectional population-based study that included 216 children aged 4-6 years from public schools in Botelhos, Brazil. Children with all second primary molars erupted were eligible for participation. Clinical examination was performed by one calibrated examiner. HSPM was recorded according to modified European Academy of Paediatric Dentistry criteria. The main outcome was dental caries experience as indicated by the dmft index (%dmft>0) according to WHO criteria. Chi-square test and Logistic Regression Model were used to adjust the results for effects of covariates Among the 216 children examined, 22.2% presented HSPM. After adjustment for logistic regression, children with HSPM were found to have a 2.28 times greater chance of presenting dental caries. Our results reinforce the importance of HSPM in caries development in children, which should be considered by public health dentists in the process of planning actions aimed at this population.

RESUMO A hipomineralizacao de segundo molar deciduo (HSMD) é de-nominação utilizada para descrever a presenga de hipomineralização demarcada do esmalte nos segundos molares decídus. A HSMD foi comparada com a hipomineralização de molares e incisivos (HMI) no que diz respeito á aparencia e as conse-quencias clínicas. O objetivo deste estudo foi investigar asso-ciações entre HSMD e cárie na infáncia. Foi realiza um estudo transversal de base populacional, composto por 216 criangas de 4 a 6 anos de idade de escolas públicas de Botelhos, Brasil. As criangas com todos os segundos molares deciduos foram elegíveis para participação. O exame clínico foi realizado por um examinador calibrado. A HSMD foi registrada de acordo com os critérios modificados da European Academy of Paediatric Dentistry. O desfecho principal foi a experiencia de cárie dentària nos dentes deciduos conforme o índice ceo (% ceo> 0), segundo os critérios da OMS. Os testes de Qui-quadrado e o modelo de regressao logística foram utilizados para ajustar os resultados dos efeitos das covariáveis. Verificou-se que entre as 216 criangas examinadas, 22,2% apresentaram HSMD. Após o ajuste da regressao logística, as criangas com HSMD tiveram 2,28 vezes mais chances de apresentar cárie dentària. Nossos resultados reforgam a importáncia do HSMD no desenvolvimento da cárie em criangas, fato que deve ser considerado pelos dentistas de saúde pública no processo de planejamento de ações voltadas a essa população.

Dental Fear in Children: Association with Dental Caries and Molar Incisor Hypomineralization

Abstract The aim of this study was to investigate the prevalence of dental fear and to evaluate its association with dental caries and molar incisor hypomineralization (MIH) in schoolchildren aged 8-10 years from a municipality in Northeastern Brazil. Data from 466 students enrolled in urban public schools in a cross-sectional study were collected. Parents/guardians answered a questionnaire addressing sociodemographic characteristics, dental fear was measured by means of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and clinical examinations were performed by three calibrated examiners for diagnosis of dental caries, using the International Caries Detection & Assessment System - ICDAS II and a previously validated index for MIH. Descriptive data analysis was performed, and associations between dental fear, dental caries and MIH were analyzed using robust Poisson regression for complex samples (p<0,05). The prevalence of dental fear was 21.6%, and the mean total CFSS-DS score was 29.97 (CI 95%=29.05-30.89). In the multivariate adjusted model, the prevalence of dental fear was associated to family income (PR=1.78; CI 95%=1.02-3.08; p= 0.041). Monthly family income was associated with dental fear in children, whereas dental caries and MIH were not associated with dental fear.

Resumo O objetivo deste estudo foi investigar a prevalência de medo odontológico e avaliar sua associação com a cárie dentária e a Hipomineralização molar-incisivo (HMI), em escolares de 8 a 10 anos, em um município da região Nordeste do Brasil. Foram coletados dados de 466 estudantes matriculados em escolas públicas urbanas, em um estudo transversal. Os pais/responsáveis responderam a um questionário abordando características sociodemográficas, o medo odontológico foi mensurado por meio do Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), e os exames clínicos foram realizados por três examinadores calibrados para o diagnóstico de cárie dentária, utilizando o índice International Caries Detection & Assessment System (ICDAS II) e, por um índice previamente validado, para HMI. Foi realizada a análise descritiva dos dados e as associações entre medo odontológico, cárie dentária e HMI foram avaliadas pela regressão robusta de Poisson para amostras complexas (p<0,05). A prevalência de medo odontológico foi de 21,6%, e o escore médio total do CFSS-DS foi de 29,97 (IC 95%=29,05-30,89). No modelo multivariado ajustado, a prevalência de medo odontológico esteve associada à renda familiar (RP=1,78; IC 95%=1,02-3,08; p= 0,041). A renda familiar mensal foi associada ao medo odontológico em crianças, enquanto a cárie dentária e a HMI não foram associadas ao medo odontológico.

Hipomineralização de molares e incisivos e doença celíaca / Molar incisor hypomineralization and celiac disease

ABSTRACT BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental enamel defect with multifactorial etiology. Although the relationship between celiac disease (CD) and developmental enamel defect was demonstrated, the association between CD and MIH is uncertain. OBJECTIVE: The objective of this study was to analyze the occurrence of MIH in CD patients. METHODS: Forty CD patients and a control group with 40 healthy individuals were selected. A calibrated examiner (k≥0.889) according to the European Academy of Pediatric Dentistry criteria performed the diagnosis of MIH. Data were analyzed by descriptive statistics and Fischer's exact test (α=0.05). RESULTS: Of the 80 participants, ten presented MIH with eight individuals with CD. Celiac patients presented 4.75 times the chance of occurrence of MIH than the control group (95% CI: 2.22-10.18; P=0.044). In all the evaluated teeth (n=978), 22 had MIH: 20 teeth in individuals with CD and two in those without the disease. All CD participants with MIH presented the classic form of the disease. CD participants showed 17 teeth (85.0%) with demarcated opacities, two (10.0%) post-eruptive collapses and one (5.0%) atypical restoration. The control group presented only demarcated opacities. CONCLUSION: CD increased the chance of MIH and associated with its clinical manifestations can assist in the diagnosis of CD.

RESUMO CONTEXTO: A hipomineralização de molares e incisivos (HMI) é um defeito de desenvolvimento de esmalte com etiologia multifatorial. Embora a relação entre doença celíaca (DC) e defeito de desenvolvimento de esmalte já tenha sido demonstrada, a associação entre DC e HMI ainda é incerta. OBJETIVO: O objetivo deste estudo foi analisar a ocorrência de HMI em pacientes com DC. MÉTODOS: Foram selecionados 40 pacientes com DC e um grupo controle com 40 indivíduos sem a doença. O diagnóstico da HMI foi realizado por examinador calibrado (k≥0,889) segundo critérios da Academia Europeia de Odontopediatria. Dados foram analisados por estatística descritiva e teste exato de Fischer (α=0,05). RESULTADOS: Dos 80 participantes, 10 apresentaram HMI sendo 8 indivíduos com DC. Pacientes celíacos apresentaram 4,75 vezes a chance de ocorrência de HMI que grupo controle (IC 95%: 2,22-10,18; P=0,044). No total dos dentes avaliados (n=978), 22 apresentaram HMI: 20 dentes em indivíduos com DC e 2 entre aqueles sem a doença. Todos os participantes com DC e portadores de HMI apresentavam a forma clássica da doença. Participantes com DC mostraram 17 (85,0%) dentes com opacidades demarcadas, 2 (10,0%) colapsos pós-eruptivos e 1 (5,0%) restauração atípica. Grupo controle apresentou apenas opacidades demarcadas. CONCLUSÃO: DC aumentou a chance de HMI e associada a manifestações clínicas da DC pode auxiliar no diagnóstico da doença.

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.

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization

Abstract This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

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.

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.

Prevalencia de defectos de desarrollo del esmalte en dentición temporal, en una población bogotana / Prevalence of developmental defects of the enamel in primary dentition in a bogotan population

RESUMEN Objetivo Determinar en un área con fluorización sistémica, la prevalencia de defectos de desarrollo del esmalte en dentición temporal de niños/niñas entre 4 y 6 años de un colegio público de Bogotá, Colombia. Método En 153 escolares se realizó muestreo aleatorio simple obteniendo 62 niños sistémicamente sanos en quienes se valoraron clínica y detalladamente los dientes. La examinadora fue calibrada con una experta en el índice modificado de Defectos de Desarrollo del Esmalte de la Federación Dental Internacional obteniendo Kappa interexaminador de 0,9 e intraexaminador de 0,8. Se contó con consentimiento informado y aprobación del estudio por parte del Comité de Ética de la Facultad de Odontología de la Universidad Nacional. Resultados La prevalencia de DDE fue de 74,2 % (IC 95 % 62,1-83,4) distribuidos en: opacidades demarcadas 86,9 % (IC 95 % 74,3-93,3), opacidades difusas 76,1 % (IC 95 % 62,4-85,7) e hipoplasias 2,2 % (IC 95 % 0,4-11,1). La combinación de defectos más frecuente en un mismo individuo fue opacidades demarcadas y difusas. El maxilar más afectado fue el superior 54,6 % y los dientes más comprometidos fueron los segundos molares 56 %. El promedio de dientes afectados con DDE por individuo fue de 4,7 ± DE 2,6. Conclusiones La alta prevalencia de defectos de desarrollo del esmalte encontrada, así la severidad haya sido baja, debe alertar a órganos decisores en salud para ejercer controles orientados a prevenirlos. Se deben realizar más estudios con metodologías estandarizadas para llegar a conocer la prevalencia global de los defectos.(AU)

ABSTRACT Objective To determine in an area with systemic fluoridation, the prevalence of development of enamel defects in children's primary teeth between 4-6 years old from a public school in Bogota, Colombia. Method A simple random sample was conducted in 153 students, obtaining 62 healthy children, detailed dental clinical assesment were performed in them. The examiner was calibrated by an expert in the modified index of Dental Enamel Defects from the International Dental Federation obtaining a kappa inter-examiner and intra-examiner measures of 0.9 and 0.8, respectively. An informed consent and approval of the study by the Ethical Committee of the School of Dentistry at the Universidad Nacional de Colombia were obtained. Results The prevalence of dental enamel defects was 74.2 % (62.1 - 83.4) 95 % CI, distributed in: demarcated opacities 86.9 % (74.3-93.3) 95 % CI, diffuse opacities 76.1 % (62.4-85.7) 95 % CI and hypoplasia 2.2 % (0.4-11.1) 95 % CI. The most frequent combination of defects in an individual was demarcated and diffuse opacities. The most affected maxilla was the superior 54.6 % and the most compromised teeth were the second molar 56 %. The average teeth affected with dental enamel defects per individual was 4.7 ± SD 2.6. Conclusions The high prevalence of dental enamel defects found, despite low severity, suggests more attention of the health authorities leading preventive programs. More studies should be done with standardized methodologies in order to estimate the overall prevalence of the defects.(AU)

Distinguishing predisposing factors for enamel hypoplasia and molar-incisor hypomineralization in children in Ile-Ife, Nigeria

Aim: To determine if the prevalence of enamel hypoplasia, molar-incisor hypomineralisation(MIH) and deciduous molar hypomineralisation (DMH) is associated with the socioeconomicstatus of the child and to determine the prevalence of enamel hypoplasia and MIH/DMH comorbidityin the study population. Methods: Information was collected on the sex andsocioeconomic status of the 1,169 study participants’ resident in Ile-Ife, Nigeria, recruited througha household survey. The children were clinically examined to assess for the presence of enamelhypoplasia, MIH and DMH. Associations between sex, socioeconomic status and the prevalenceof enamel hypoplasia, MIH and DMH were determined. The proportion of children with enamelhypoplasia and MIH/DMH co-morbidity was also determined. Results: Among the 1,169 studyparticipants, 47(4.0%) had MIH, 15 (1.3%) had DMH and 161 (13.8%) had enamel hypoplasia. One (0.09%) study participant had MIH/DMH co-morbidity, 12 (1.0%) had DMH/enamel hypoplasiaco-morbidity, and 9 (0.8%) had MIH/hypoplasia co-morbidity. There was no significant associationbetween the socioeconomic status and presence of enamel hypoplasia (p=0.22), MIH (p=0.78) orDMH (p=1.00). Conclusions: The socioeconomic status cannot be used as a distinguishing factorfor enamel hypoplasia, MIH and DMH. The possibility of co-existence of enamel hypoplasia andMIH/DMH makes it imperative to find ways to distinguish between the lesions.

Comparación de la prevalencia de hipomineralización molar incisiva en niños con diferente cobertura asistencial en las ciudades de Buenos Aires (Argentina) y Montevideo (Uruguay) / Comparison of the prevalence of molar incisor hypomineralization among children with different health care coverage in the cities of Buenos Aires (Argentina) and Montevideo (Uruguay)

El objetivo fue comparar la frecuencia de la hipomineralización molar incisiva (HMI) entre niños con diferente cobertura de salud en Buenos Aires y Montevideo. Se diseñó un estudio transversal, observacional y descriptivo con los nacidos entre 1993-2003, asististidos en las Cátedras de Odontología Integral Niños (Universidad de Buenos Aires) y de Odontopediatría (Universidad de la República) y en cinco clínicas privadas, entre abril y diciembre 2010. Se conformaron dos grupos: A (Buenos Aires; n=1.090) y B (Montevideo; n=626). El diagnóstico clínico fue realizado por examinadores calibrados (Kappa: 0,94) con los criterios de Mathu-Muju y Wright. Los resultados mostraron una prevalencia de HMI en A del 16,1% y en B del 12,3% (p=0,03), con diferencias significativas entre los sectores público y privado en ambos grupos (A p=0,0008; B p=0,0004) y una correlación positiva entre la HMI y el año de nacimiento (A p=0,001; B p=0,005) Los resultados permiten concluir que la HMI es una patología emergente y su prevalencia se relaciona al año de nacimiento y al acceso al cuidado de salud.

The aim of this study was to compare the prevalence of molar incisor hypomineralization (MIH) among children with different health care coverage in Buenos Aires and Montevideo. An observational, cross-sectional and descriptive study was designed, considering children born from 1993-2003 who were seen in the Chairs of Comprehensive Children's Dentistry (Universidad de Buenos Aires) and of Pediatric Dentistry (Universidad de la República) and at five private dental offices between April and December 2010. Two groups were defined: A (Buenos Aires; n=1,090) and B (Montevideo; n=626). The clinical diagnosis was carried out with calibrated examiners (Kappa: 0.94) using the Mathu-Muju and Wright criteria. The prevalence of MIH was found to be 16.1% in A and 12.3% in B (p=0.03), with statistically significant differences between the public and private care sectors in both groups (A p=0.0008; B p=0.0004) and a positive correlation between MIH and year of birth (A p=0.001; B p=0.005). The results show that MIH is an emerging pathology and that MIH prevalence is related to year of birth and access to health care.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.

Prevalência de defeitos de esmalte em indivíduos portadores de fissuras labiopalatinas da Paraíba, Brasil / Prevalencia de amelogénesis imperfecta en pacientes con labio y paladar fisurados en Paraíba, Brasil / Prevalence of defective amelogenesis in patients with palatoschisis in Paraíba, Brazil

Os defeitos de esmalte estão entre as alterações que acometem os indivíduos portadores de fissuras labiopalatinas. O propósito do presente estudo foi descrever a prevalência de defeitos de esmalte em indivíduos portadores de fissuras, bem como a sua distribuição quanto ao tipo de fissura e lado fissurado, nos pacientes que procuraram o serviço de referência em ortodontia no atendimento de fissurados da Paraíba, Brasil. Para tanto, este estudo caracterizou-se por ser do tipo transversal e observacional, adotando como estratégia de coleta de dados o exame clínico em 76 indivíduos portadores de fissuras pós e transforame incisivo unilateral ou bilateral, de ambos os sexos, com média de idade de 13,3 anos. O exame foi realizado nos dentes incisivos e caninos superiores, por dois examinadores previamente treinados (kappa= 0,89). Os pacientes incluídos foram todos que estavam em atendimento no período de janeiro a junho de 2011 em que as faces vestibulares dos dentes a serem examinados permitissem a avaliação clínica. Foram excluídos os que apresentavam outras deformidades associadas e que não tivessem sido submetidos às cirurgias primárias. Os dados foram submetidos à estatística descritiva e ao teste estatístico qui-quadrado, sendo significativo ao nível de 5 porcento. Houve predominância do gênero masculino (57,9 porcento) e da fissura transforame incisiva unilateral esquerda (40,8 porcento). Em relação ao defeito de esmalte, o dente mais acometido foi o incisivo central, a maioria dos examinados apresentou opacidade difusa (14,9 porcento), seguida pela presença de opacidade demarcada (13,15 porcento) e opacidade mais hipoplasia (10,9 porcento) e houve diferença estatística significativa (p< 0,00001) entre o lado fissurado e o contralateral. Os resultados mostram elevada frequência de defeitos de esmalte nos pacientes estudados, particularmente nos casos bilaterais e nos dentes adjacentes à fissura(AU)

The enamel defects are some of the changes affecting persons with palatoschisis. The aim or present paper was to describe the prevalence of enamel defects with labial and palatine fissure, as well as its distribution by type of fissure in patients came to Orthodontics service of Paraíba, Brazil. A cross-sectional and observational study was conducted to collect data from the postmortem physical examination of 76 patients with palatoschisis through the unilateral and bilateral incisor foramen, of both sexes and a mean age of 13.3 years. The examination was performed in the upper incisor and canines by two examiners previously trained (kappa= 0.89). Patients included were those came to service from January to June, 2011, where the vestibular surfaces of teeth allowed a clinical assessment. Those with malformations and no primary surgery were excluded. Data were analyzed by descriptive statistics and Chi² test with a significance of 5 percent. The male sex accounted for 57.9 percent and the left unilateral fissure was of 40.8 percent. In relation to enamel defects, the more involved tooth was the central incisor and a diffuse opacity for a 14.9 percent followed by the presence of limited opacity for a 13.15 percent and hypoplasia for a 10.9 percent. There were statistically significant differences (p< 0.00001) between fissure and the contralateral side. Results showed the high frequency of enamel defects in the study patients, mainly in bilateral cases and in teeth adjacent to fissure side(AU)

Los defectos en el esmalte son algunos de los cambios que afectan a las personas con labio y paladar fisurados. El propósito de este estudio fue describir la prevalencia de defectos del esmalte con fisura labial y palatina, así como su distribución por tipo de fisura, en los pacientes que asistieron al servicio de ortodoncia de Paraíba, Brasil. Se realizó un estudio transversal y observacional donde se recolectaron datos del examen clínico en 76 pacientes con fisura post foramen, trans foramen incisivo unilateral o bilateral, de ambos sexos y con una edad media de 13,3 años. El examen fue realizado en los dientes incisivos y caninos superiores, por dos examinadores previamente capacitados (kappa= 0,89). Los pacientes incluidos fueron los que asistieron al servicio durante el periodo de enero a junio de 2011, en los que las superficies vestibulares de los dientes que se examinaron permitieron una evaluación clínica. Se excluyeron aquellos con malformaciones y que no habían sido sometidos a cirugía primaria. Los datos fueron sometidos a estadística descriptiva y chi-cuadrado con una significación de 5 por ciento. El sexo masculino representó el 57,9 por ciento y la fisura unilateral izquierda fue de un 40,8 por ciento. En relación con defectos en el esmalte, el diente más afectado fue el incisivo central, mostraron opacidad difusa para un 14,9 por ciento, seguido por la presencia de opacidad limitada para un 13,15 por ciento e hipoplasia con un 10,9 por ciento. Se encontraron diferencias estadísticamente significativas (p< 0,00001) entre la fisura y el lado contralateral. Los resultados mostraron la alta frecuencia de defectos del esmalte en los pacientes estudiados, principalmente en los casos bilaterales y en los dientes adyacentes al lado de la fisura(AU)

Prevalence of molar-incisor hypomineralization (MIH) in children seeking dental care at the School of Dentistry of the university of Buenos Aires (Argentina) and University of La Republica (Uruguay)

Los datos sobre prevalencia de MIH en Latinoamérica son escasos. Los objetivos de este trabajo son comparar la prevalencia de MIH en niños que demandaron atención en las Cátedras de Odontología Integral Niños de la Universidad de Buenos Aires (FOUBA) y de Odontopediatría de la Universidadde la República (UdelaR) y analizar en ambas unidades académicas la distribución según la variable año de nacimiento, sexo, edad, número de piezas afectadas y máxima severidaden molares e incisivos. 9 docentes de ambas facultades (Kappa= 0.94) evaluaron durante el periodo lectivo del año 2010 a todos los niños nacidos entre 1993 y 2003 que presentabanerupcionados los 4 primeros molares y los 8 incisivos permanentes y que concurrieron espontáneamente a ambasunidades académicas para su atención odontológica integral. Después de una profilaxis, las piezas fueron clínicamente evaluadas con luz del foco, previamente secadas, registrando en planillas diseñadas para tal fin, sexo, año de nacimiento, institución de pertenencia, presencia de MIH, número de incisivosy molares afectados y máximo grado de severidad. La severidad se cuantificó a través de su aspecto en: Normal (0), Blanco crema (1), Amarillo marrón (2) y Pérdida de esmalte (3). Se conformaron dos grupos: UBA: A (n=512) y UdelaR: B (n=463). Los datos obtenidos fueron analizados estadísticamente utilizando porcentajes con sus correspondientes intervalos de confianza del 95 por ciento para la descripción de la prevalencia y otras variables cualitativas; Test Exacto de Fisher para la comparación de las proporciones y Test de Welch para la comparación de las edades. Resultados: Fueron evaluados 975 niños, edad media: 11.6 ± 2,67 años. No se observaron diferencias significativas entre los grupos en relación a las variables edad (p=0.95) y sexo (p=0.30). La prevalencia de MIH del total de la muestra fue de 6.56 por ciento, sin diferencias significativas entre A y B (p= 0.76).

Prevalência de defeitos de desenvolvimento de esmalte na dentição decídua adquiridos na vida intrauterina / Developmental enamel defects prevalency in primary dentition acquired in intrauterine life

Este artigo tem como objetivo estimar a prevalência de defeitos de desenvolvimento de esmalte (DDE) na dentição decídua. Foi desenvolvido estudo descritivo com 205 crianças de 12-60 meses nascidas no município de São Luís, MA, Brasil. Realizou-se exame clínico oral, entrevista com responsáveis e avaliação dos prontuários. Para diagnóstico e classificação dos DDE utilizou-se o Índice Modificado de Defeitos de Desenvolvimento de Esmalte e analisou-se a frequência dos dados. Concluiu-se que estipular uma frequência de defeitos de esmalte exclusivos à fase gestacional é inovador e contribui sobremaneira para que seja reduzido o conflito de resultados entre estudos que analisam fatores de risco para o DDE, pois se estabelece uma metodologia que reduz os erros de diagnóstico nessas pesquisas.

Prevalence of molar incisor hypomineralization in the city of Buenos Aires

La prevalencia de la hipomineralización molar incisva (MIH) es en nuestro país aún desconocida. Los objetivos de este estudio fueron: estimar la prevalencia de MIH en un grupo de niños que demandaron atención en la Ciudad Autónoma de Buenos Aires; analizar su distribución de acuerdo al año de nacimiento, y comparar prevalencia y severidad de acuerdo a la accesibilidad a los servicios de salud. Se diseñó un estudio prospectivo, observacional, transversal y descriptivo, sobre la población infantil que demandó atención en la Cátedra de Odontología Integral Niños y en 3 consultorios odontopediátricos de los miembros del equipo de trabajo, ubicados en la ciudad de Buenos Aires (Kappa 0.933 0.911-0.952), en el período comprendido entre abril y agosto de 2010. Fueron incluidos todos los niños nacidos entre 1993 y 2003 que presentaban erupcionados los 4 primeros molares y los 8 incisivos permanentes. Después de una profilaxis, las piezas fueron clínicamente evaluadas con luz del foco, previamente secadas, registrando en planillas diseñadas para tal fin, sexo, fecha de nacimiento, tipo de acceso a la atención, presencia de MIH, número de incisivos y molares afectados y máximo grado de severidad registrado en cada pieza. Para el análisis de los datos se utilizaron porcentajes, test exacto de Fisher y regresión lineal. Fueron evaluados 1098 niños de 11.3 años (11.08-11.39). La prevalencia obtenida fue del 15.9 por ciento (13.8-18.2). Con respecto al año de nacimiento se observó una correlación positiva y altamente significativa (p<0.0001). El grupo A (modalidad prepago) quedó conformado por 586 niños y el B (hospital público universitario) por N=512. En A, la prevalencia de MIH fue deld 24.40 por ciento y en B de 6,44 por ciento (p<0,0001). El 37 por ciento (32.2-42) de los molares afectados de A y el 13.7 por ciento (6.7-23.8) de B presentaban lesiones de grado 3, con pérdida de esmalte (p0,0001). En este estudio, la MIH se presentó como una patología frecuente.