Predictors of Developmental Defects of Enamel in Primary Maxillary Central Incisors Using Bayesian Model Selection.

INTRODUCTION: Localized non-inheritable developmental defects of tooth enamel (DDE) are classified as enamel hypoplasia (EH), opacity (OP), and post-eruptive breakdown (PEB) using the enamel defects index. To better understand the etiology of DDE, we assessed the linkages amongst exposome variables for these defects during the specific time duration for enamel mineralization of the human primary maxillary central incisor enamel crowns. In general, these two teeth develop between 13 and 14 weeks in utero and 3-4 weeks' postpartum of a full-term delivery, followed by tooth eruption at about 1 year of age. METHODS: We utilized existing datasets for mother-child dyads that encompassed 12 weeks' gestation through birth and early infancy, and child DDE outcomes from digital images of the erupted primary maxillary central incisor teeth. We applied a Bayesian modeling paradigm to assess the important predictors of EH, OP, and PEB. RESULTS: The results of Gibbs variable selection showed a key set of predictors: mother's prepregnancy body mass index (BMI); maternal serum concentrations of calcium and phosphorus at gestational week 28; child's gestational age; and both mother's and child's functional vitamin D deficiency (FVDD). In this sample of healthy mothers and children, significant predictors for OP included the child having a gestational period >36 weeks and FVDD at birth, and for PEB included a mother's prepregnancy BMI <21.5 and higher serum phosphorus concentration at week 28. CONCLUSION: In conclusion, our methodology and results provide a roadmap for assessing timely biomarker measures of exposures during specific tooth development to better understand the etiology of DDE for future prevention.

Enfoque de Tratamiento de una Adolescente con Amelogénesis Imperfecta / Treatment Approach for an Adolescent with Amelogenesis Imperfecta

La amelogénesis imperfecta (AI) es un grupo de tras-tornos hereditarios, clínica y etiológicamente hete-rogéneos, derivados de mutaciones genéticas, que se caracterizan por anomalías cualitativas y cuanti-tativas del desarrollo del esmalte, pudiendo afectar la dentición primaria y/o permanente. El tratamiento del paciente con AI es complejo y multidiscliplinario; supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afecta no solo la salud buco dental sino el aspecto emocional y psicológico de los pacientes. Con el obje-tivo de describir el tratamiento integral y rehabilita-dor realizado en una paciente con diagnóstico de AI tipo III, se reporta el caso de un adolescente de sexo femenino de 13 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), cuyo motivo de consulta fue la apariencia estética y la hipersensibilidad de sus pie-zas dentarias. Durante el examen clínico intraoral, se observó que todas las piezas dentarias presentaban un esmalte rugoso, blando, con irregularidades y una coloración amarronada, compatible con diagnóstico de Amelogénesis Imperfecta tipo III hipomineralizada. Conclusión: El tratamiento rehabilitador de la AI en los pacientes en crecimiento y desarrollo estará diri-gido a intervenir de manera integral y temprana para resolver la apariencia estética y funcional, evitar las repercusiones sociales y emocionales, y acompañar a los pacientes y sus familias (AU)

Amelogenesis imperfecta (AI) is a group of clinically and etiologically heterogeneous hereditary disorders, derived from genetic mutations, characterized by qualitative and quantitative anomalies of enamel development, which can affect primary and/or permanent dentition. The treatment of patients with AI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehensive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of type III AI. Case report: The case of a 13-year-old female patient, who required dental attention at the Department of Dentistry for Children of the School of Dentistry of the University of Buenos Aires, whose reason for consultation was esthetic appearance and hypersensitivity of her teeth. In the intraoral clinical examination, it was observed that all the teeth had rough, soft enamel, with irregularities and a brownish color, compatible with the diagnosis of type III hypomineralized Amelogenesis Imperfecta. Conclusion: Rehabilitative treatment of AI in growing and developing patients will be aimed at early and comprehensive intervention to resolve esthetic and functional appearance, avoid social and emotional repercussions and accompany patients and their families (AU)

Photobiomodulation therapy for hypersensitivity associated with molar-incisor hypomineralization: a case report.

Molar-incisor hypomineralization (MIH) is a qualitative defect of the dental enamel on permanent first molars and may be associated with permanent incisors. There is currently no defined therapeutic protocol for managing the hypersensitivity associated with this condition. The present case report describes the treatment of a patient with MIH and the impact on the patient's quality of life as assessed using the Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14). The maxillary central incisors, maxillary and mandibular first molars, and mandibular right canine of an 11-year-old girl were compromised by MIH. The long version of the CPQ11-14 was self-administered before treatment. Initially, the patient reported hypersensitivity of her maxillary right central incisor, maxillary and mandibular left first molars, and mandibular right canine when consuming cold food and beverages. This was confirmed by applying a jet of air to the teeth and asking the patient to report the level of sensitivity using the Wong-Baker FACES Pain Rating Scale. The patient reported that hypersensitivity was present every day or almost every day. Desensitizing treatment included 4 applications of photobiomodulation therapy (infrared diode laser) and 4 applications of fluoride varnish. After desensitization, the maxillary central incisors received direct composite resin restorations, while the maxillary left first molar, which had an amalgam restoration and recurrent caries, received a resin-modified glass ionomer cement restoration. At the conclusion of the treatment, the patient completed the CPQ11-14 again and reported less difficulty with consuming hot and cold foods and beverages, indicating that treatment had reduced hypersensitivity and its negative impact on her quality of life.

Oculocerebrorenal Lowe syndrome: a literature review and two case reports.

The present paper reviews the dental findings in oculocerebrorenal Lowe syndrome and presents two case histories. Reports of different patients are useful in order to enhance knowledge about the syndrome, because there are so many different oral manifestations.

Dietary variation and stress among prehistoric Jomon foragers from Japan.

Current archaeological evidence indicates that greater dietary reliance on marine resources is recorded among the eastern Jomon, while plant dependence prevailed in western/inland Japan. The hypothesis that the dietary choices of the western/inland Jomon will be associated with greater systemic stress is tested by comparing carious tooth and enamel hypoplasia frequencies between the eastern and western/inland Jomon. Demographic collapse coincides with climate change during the Middle to Late Jomon period, suggesting dwindling resource availability. It is hypothesized that this change was associated with greater systemic stress and/or dietary change among the Middle to Late Jomon. This hypothesis is tested by comparing enamel hypoplasia and carious tooth frequencies between Middle to Late and Late to Final Jomon foragers. Enamel hypoplasia was significantly more prevalent among the western/inland Jomon. Such findings are consistent with archaeological studies that argue for greater plant consumption and stresses associated with seasonal resource depletion among the western/inland Jomon. Approximately equivalent enamel hypoplasia frequencies between Middle to Late and Late to Final Jomon foragers argues against a demographic collapse in association with diminished nutritional returns. Significant differences in carious tooth frequencies are, however, observed between Middle to Late and Late to Final Jomon foragers. These results suggest a subsistence shift during the Middle to Late Jomon period, perhaps in response to a changed climate. The overall patterns of stress documented by this study indicate wide-spread environmentally directed biological variation among the prehistoric Jomon.

Enamel hypoplasia in a litter of rats with alloxan-induced diabetes mellitus.

Enamel hypoplasia is an important clinical problem commonly seen in children born to diabetic women. We aimed to characterize the enamel hypoplasia in Wistar rats born to alloxan-induced diabetes mellitus rats. Groups consisted of pregnant rats supplemented (ISDR) or not (NISDR) with insulin and controls, in which sterile saline solution was administered instead of alloxan or insulin. The mandibular incisors of one-month-old rats born to these mothers were analyzed. Whitish defective enamel was found macroscopically in both experimental groups (ISDR = 37.5%, NISDR = 33.3%) but not in the control group. Mild to severe enamel hypoplasia was observed by scanning electron microscopy (ISDR = 93.8%; NISDR = 100%, control = 4.2%). The severity of hypoplasia correlated positively with the maternal level of blood glucose. In conclusion, the intensity of enamel hypoplasia in the teeth of the litter born to alloxan-induced diabetic rats was variable and was dependent on the glycemic level of the pregnant rat.

Enamel hypoplasia in a litter of rats with alloxan-induced diabetes mellitus

Enamel hypoplasia is an important clinical problem commonly seen in children born to diabetic women. We aimed to characterize the enamel hypoplasia in Wistar rats born to alloxan-induced diabetes mellitus rats. Groups consisted of pregnant rats supplemented (ISDR) or not (NISDR) with insulin and controls, in which sterile saline solution was administered instead of alloxan or insulin. The mandibular incisors of one-month-old rats born to these mothers were analyzed. Whitish defective enamel was found macroscopically in both experimental groups (ISDR = 37.5 percent, NISDR = 33.3 percent) but not in the control group. Mild to severe enamel hypoplasia was observed by scanning electron microscopy (ISDR = 93.8 percent; NISDR = 100 percent, control = 4.2 percent). The severity of hypoplasia correlated positively with the maternal level of blood glucose. In conclusion, the intensity of enamel hypoplasia in the teeth of the litter born to alloxan-induced diabetic rats was variable and was dependent on the glycemic level of the pregnant rat

Enamel defects in primary and permanent teeth of children born prematurely.

The objective of this study was to determine the prevalence of enamel defects in both primary and permanent dentitions of the same preterm children, and to elucidate the role of early dietary mineral and vitamin D intake in the etiology of the enamel defects. The status of the primary and permanent teeth was evaluated in 32 preterm children and in 64 control children. The prevalence of enamel defects in children born preterm was clearly higher as compared with controls in both the primary (78% vs 20%, P<0.001) and permanent (83% vs 36%, P<0.001) dentitions. Neither the mineral supplementation used nor a vitamin D dose of 1000 IU/day, as compared with a lower dose of 500 IU/day, reduced the prevalence of enamel defects in the primary or permanent dentitions. Further studies are needed to clarify whether achieving near optimum intra-uterine mineral retention would lower the prevalence of subsequent enamel defects in infants born prematurely.

Defeitos hipoplásicos do esmalte dentário: revisäo da literatura) / Hypoplasics defects in dental enamel: review of the literature)

Através de uma revisäo da literatura os autores fazem uma ampla abordagem dos defeitos hipoplásicos do esmalte, elucidando aspectos sobre os principais fatores sistêmicos e locais que podem afetar os ameloblastos durante o processo da odontogênese, determinando as hipoplasias. Também säo discutidas as dificuldades clínicas do diagnóstico, sua correlaçäo com os dados obtidos durante a anamnese; os dentes mais afetados; a prevalência de cárie associada à esta alteraçäo e os diferentes tipos de "índex" utilizados pelos autores para a classificaçäo e determinaçäo desta anomalia

Environmental causes of enamel defects.

A large number of causes of enamel defects, both environmental and genetic, have been described. However, many of these are derived from case histories and studies of individual conditions. What is needed now is a systematic investigation of the problem. The first requirement in exploring the aetiology further is the standardization of both the clinical diagnosis and the descriptive terminology. This has been provided by the Fédération Dentaire Internationale Developmental Defects of Enamel Index. Comparing studies using standardized methods, including this index, has highlighted areas for closer investigation. The total prevalence of enamel defects in a population needs to be established as a baseline for studies on aetiology. Sixty-eight per cent of 1518 school children in London have enamel defects in the permanent dentition, with 10.5% having 10 or more teeth affected and 14.6% having hypoplasia, i.e. missing enamel. These findings are in contrast to the 37% with hypoplasia found in a group of third to fifth century Romano-Britons from Dorset, England, suggesting further consideration of possible environmental and genetic differences between the two populations. An overall long-term study of dental development in low birth weight children has shown significantly more (P < 0.001) enamel defects related to major health problems during the neonatal period. By using standardized, reproducible criteria in prevalence studies to gain an overview of the problem and then studying specific groups or conditions, it is possible to identify general and specific factors in the aetiology of enamel defects and investigate further the varying role of genetic and environmental effects.

Enamel mineral composition of normal and cystic fibrosis transgenic mice.

The ability of ameloblasts and the enamel organ to control the influx of ions into the developing enamel is of considerable interest. The development of transgenic mice lacking a cAMP-regulated chloride channel, the cystic fibrosis transmembrane conductance regulator (CFTR), provides a model that may prove valuable for the study of ion regulation in developing teeth. The purpose of this investigation was to characterize the mineral content of normal and CF mice. Five homozygous and five heterozygous adult mice having the CFTR knockout transgene were evaluated. The mice were killed with CO2 and their mandibular incisors removed, embedded in methacrylate, and sectioned, and enamel particles from the incisal region were then dissected for analysis. Each particle was analyzed for its calcium, phosphorus, and magnesium content. The normal mice had a mean mineral content of 80.5%, in contrast to the CF mice, that had markedly hypomineralized enamel (mean = 51.5%). The calcium/phosphorus ratios were similar for both groups of mice and were compatible with the enamel consisting primarily of hydroxyapatite mineral. The enamel magnesium content was significantly elevated in the CF mice (mean = 3560 ppm) compared with the normal mice (mean = 2280 ppm). Normal mouse enamel was highly mineralized, while the CF mouse enamel mineral content was significantly reduced and had an elevated level of magnesium. The altered mineral content of CF mouse enamel indicates that CFTR could play an important role in ion regulation and consequently mineralization of mouse enamel.

Changes in the plasma electrolytes and metabolites of the rat following acute exposure to sodium fluoride and strontium chloride.

Acute exposure of rats to strontium or fluoride by i.p. injection of sodium fluoride or strontium chloride resulted in a systemic response in which changes occurred in the plasma electrolytes and metabolites. Strontium resulted in a rapid but temporary hypercalcaemia while fluoride produced a temporary hypocalcaemia. There was no significant hypophosphataemia after fluoride and only a transient hypophosphataemia with strontium. There was some indication of kidney damage and a general stress response following fluoride injection. These results do not support the hypothesis that interglobular dentine is associated with hypophosphataemia or hypoplastic enamel with hypocalcaemia and are in conflict with the observation that the formation of interglobular dentine following the injection of lead acetate is associated with hyperphosphataemia and hypercalcaemia.

Enamel hypoplasia and age at weaning in 19th-century Florence, Italy.

A sample representing a population of the Florence district of middle 19th century was studied to determine the age of occurrence of enamel hypoplasias. The age interval most affected was that between 1.5 and 3.5 years. Historical sources on weaning habits of 19th-century Italian populations indicate a weaning period between 12 and 18 months. This is in agreement with the data on enamel defects, showing that children of post-weaning age are more subject to stress. Wide "grooves", with prolonged duration, are concentrated between 2 and 2.5 years, whereas "lines" occur primarily between 2.5 and 3 years. We suggest that this distribution could reflect the gradual introduction of dietary supplements until weaning is complete.

Response of bone and enamel formation to nutritional supplementation and morbidity among malnourished Guatemalan children.

The effects of changes in nutritional and health status upon bone and enamel development are examined in a sample of 63 rural Guatemalan children (24 females, 39 males). The number of ossified hand-wrist centers at 3 years and the number of linear enamel hypoplasias (LEH) in approximately 0-3 year zones of developing teeth were used to monitor the response of bone mineralization and enamel matrix formation to illness and nutritional supplementation. Numbers of ossified centers and LEH were compared across sex, supplementation, and morbidity groups. Enamel matrix secretion responded positively to increased supplementation. Children who received less than 34.25 kcal/day in supplement had more LEH than those who received more supplement. No differences in ossification status were found between supplementation groups. These data suggest that enamel formation may be more sensitive to changes in nutritional status than is bone mineralization. Disruptions of bone and enamel formation were both associated with frequent illness. Children who were ill more than 3.6% of the time had more LEH and fewer ossified hand-wrist centers than children who were less frequently ill. Conclusions regarding relative environmental sensitivity must take into account the specific aspects of dental and skeletal development examined.

Dental manifestations of autoimmune hypoparathyroidism.

The histopathologic changes in three permanent molars from two siblings with autoimmune hypoparathyroidism as part of candida endocrinopathy syndrome are described. These teeth developed after the diagnosis of hypoparathyroidism and while each subject was receiving vitamin D and calcium supplementation. The pathogenesis of the dental changes is unknown, but it is possible that parathormone may directly influence tooth development independent of its role in calcium and phosphorous homeostasis.

Enamel defects in primary canines related to traditional treatment of teething problems in Sudan.

In parts of Sudan and some other countries, teething is thought to be the cause of severe health problems in infants, and a traditional treatment involves lancing the alveolar process over the unerupted canines with a heated needle, a procedure known as 'haifat'. Three hundred and ninety-eight children aged 4-8 years were examined for the presence of enamel defects on primary canines, and their parents or guardians were questioned regarding past teething problems and their treatment. Two hundred and fifty-eight (65%) of the children had experienced health problems that had been attributed to teething, and 89 (22%) had been subjected to 'haifat'. 'Haifat' had been practised by all socio-economic groups, but was most prevalent in the lower groups. Enamel defects on the buccal surface of the primary canines were found in 25 (28%) of the children in the 'haifat' group and in 25 (8%) of the other children.

[Some clinical-laboratory indices in children with dental dysplasia of permanent teeth]. / Niakoi klnikolaboratorni pokazateli pri detsa sus zubna displaziia na postoiannite zubi.

The authors studied some serum indices of protein and electrolyte metabolism (total protein, protein fraction, serum calcium, ionized calcium, phosphorus, potassium, sodium, osmolality, Ca/P ratio) in 26 clinically healthy children, aged fro 7 to 10, with clinically diagnosed dysplasia (hypoplasia or hypomineralization) of the permanent teeth. The mean values of the single biochemical parameters for both groups of children remain within referent limits of the respective indices for childhood, and their comparison established no statistically significant differences (p greater than 0.05). That provided grounds the authors to associate with the opinion that enamel defects, localized on a restricted part of the clinical crown of a symmetric group of teeth, could be "markers" for disorders in protein and mineral metabolism only during a certain time period coinciding with the active phases of odontogenesis. The absence of lasting changes in those two metabolisms determined the trends of the secondary prophylaxis--caries-prophylactic measures aiming at the avoidance of complications.

The chronological distribution of enamel hypoplasia in human permanent incisor and canine teeth.

The frequencies and chronology, based on a standard tooth development chart, of enamel hypoplasia derived from permanent upper central incisors and mandibular canines were compared for 42 prehistoric Amerindians. Between 0.5 and 4.5 years, when the crowns of both these teeth are developing, hypoplasias were 1.36 times more common on the incisors (54 hypoplasias/incisor; 40 hypoplasias/canine). Hypoplasias on incisors occurred earlier (mean = 2.50; median at 2.0-2.5 years) compared to the canine (mean = 3.51; median at 3.5-4.0 years). Differences in published frequencies and chronologies of hypoplasias may be explained, in part, by an indefinable variation in the teeth studied. The highest density of hypoplasias on both tooth crowns was just cervical to the midpoint, suggesting that developmental rates and crown geometry may influence the ability of the crown to record stressful events.