Genes Regulating Immune Response and Amelogenesis Interact in Increasing the Susceptibility to Molar-Incisor Hypomineralization.

Ameloblasts are sensitive cells whose metabolism and function may be affected by inflammatory stimuli. The aim of this study was to evaluate the possible association between polymorphisms in immune response-related genes and molar-incisor hypomineralization (MIH), and their interaction with polymorphisms in amelogenesis-related genes. DNA samples were obtained from 101 nuclear families that had at least 1 MIH-affected child. Eleven single-nucleotide polymorphisms (SNPs) were investigated in immune response genes using TaqMan® technology allele-specific probes. A transmission disequilibrium test was performed to verify overtransmission of alleles in all MIH families, as well as in families only with mild or severe MIH-affected children. Gene-gene interactions between the immune-related and amelogenesis-related polymorphisms were analyzed by determining whether alleles of those genes were transmitted from heterozygous parents more often in association than individually with MIH-affected children. In severe cases of MIH, significant results were observed for rs10733708 (TGFBR1, OR = 3.5, 95% CI = 1.1-10.6). Statistical evidence for gene-gene interactions between rs6654939 (AMELX) and the SNPs rs2070874 (IL4), rs2275913 (IL17A), rs1800872 (IL10), rs1800587 (IL1A), and rs3771300 (STAT1) was observed. The rs2070874 SNP (IL4) was also significantly overtransmitted from heterozygous parents with the rs7526319 (TUFT1) and the rs2355767 (BMP2) SNPs, suggesting a synergistic effect of the transmission of these alleles with susceptibility to MIH. This family-based study demonstrated an association between variation in TGFBR1 and MIH. Moreover, the polymorphisms in immune response and amelogenesis genes may have an additive effect on the risk of developing MIH.

Caries treatment decisions among undergraduate and postgraduate students supported by visual detection systems.

BACKGROUND: The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention. AIM: This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria. DESIGN: Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers' consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables. RESULTS: Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non-operative treatments for the same lesions. CONCLUSIONS: IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.

Examiner's experience and the outcome interpretation of ICDAS and Nyvad's system - a prospective in vitro study.

OBJECTIVE: To evaluate, prospectively, the influence of examiner's experience in interpreting and applying the caries detection systems ICDAS (IC) and Nyvad (NY). MATERIAL AND METHODS: Twelve second-year undergraduate dental students (UG) and 12 postgraduates (PG) MSc level analysed and codified 77 clinical dental caries photographs at three different moments: initially, without any training; after one week of receiving training through a theoretical class; and after two years. Reproducibility and correlation was evaluated; sensitivity, specificity and area under ROC curve (AUC) were dichotomized according to the presence of cavitation (IC) and in relation to disease activity (NY). RESULTS: IC presented good kappa values for the first two evaluations. Both criteria resulted in good Spearman's correlation after two years (IC = UG: 0.89; PG: 0.93/NY = UG: 0.81; PG: 0.82). Sensitivity, specificity and AUC were statistically higher in the third evaluation by UG for Nyvad. CONCLUSIONS: ICDAS criteria seem to be instinctively understood by students without clinical experience. Nyvad's concepts performed better after two years where the students deepened their theoretical knowledge and experienced clinical practice, collaborating with the identification of activity signs.

Caries Detection around Restorations Using ICDAS and Optical Devices.

PURPOSE: Secondary caries is the major reason for replacement of restorations in operative dentistry. New detection methods and technology have the potential to improve the accuracy for diagnosis of secondary carious lesions. This in vitro study evaluated the performance of the ICDAS (International Caries Detection and Assessment System) visual criteria and optical devices for detecting secondary caries around amalgam and composite resin restorations in permanent teeth. MATERIALS AND METHODS: A total of 180 extracted teeth with Class I amalgam (N = 90) and resin composite (N = 90) restorations were selected. Two examiners analyzed the teeth twice using the visual criteria (ICDAS), laser fluorescence (LF), light-emitting diode device (MID), quantitative light-induced fluorescence system (QLF), and a prototype system based on the Fluorescence Enamel Imaging technique (Professional Caries Detection System, PCDS). The gold standard was determined by means of confocal laser scanning microscopy. RESULTS: High-reproducibility values were shown for all methods, except for MID in the amalgam group. For both groups the QLF and PCDS were the most sensitive methods, whereas the other methods presented better specificity (p < 0.05). CONCLUSION: All methods, except the MID device appeared to be potential methods for detecting secondary caries only around resin composite restorations, whereas around amalgam restorations all methods seemed to be questionable. CLINICAL SIGNIFICANCE: Using Internal Caries Detection and Assessment System (ICDAS), an LF device, quantitative light-induced fluorescence and a novel method based on Fluorescence Enamel Imaging technique may be effective for evaluating secondary caries around composite resin restorations.

Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth.

AIM: To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. DESIGN: Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. RESULTS: Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. CONCLUSION: The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

Dental caries experience and Molar-Incisor Hypomineralization.

OBJECTIVE: This cross-sectional study assessed the prevalence and severity of the enamel defects, known as Molar-Incisor Hypomineralization (MIH) and its relationship to dental caries. MATERIALS AND METHODS: A sample of 1157 schoolchildren (population based), aged 6-12 years, of the Araraquara city-Brazil, was evaluated according to the European Academy of Paediatric Dentistry (EAPD) criteria by two trained examiners. The dental impact caused by MIH was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index (WHO). Data were analyzed using ANOVA and Chi-square tests (p < 0.05). The socioeconomic status was collected using a questionnaire answered by parents. RESULTS: The prevalence of MIH was 12.3%. Mild impairment was the most frequent diagnosis. DMFT of children with MIH was 0.89 (± 1.18), which are higher than those of the unaffected group (0.43 ± 1.01). An association was found between dental caries only in the permanent dentition of children with MIH (p = 0.0001). Family income was considered low in 85% of the families of children with MIH in the public system, while in private school it was 18% (p < 0.05). CONCLUSION: The prevalence of MIH in Araraquara was associated with greater caries experience in the permanent dentition.

Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial.

INTRODUCTION: Molar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim of the proposed study is to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) on permanent teeth with MIH through decontamination and sensitivity control. METHODS AND ANALYSIS: Patients from 8 to 12 years of age with permanent molars will be randomly allocated to three groups. Group 1: selective chemical-mechanical removal of carious dentinal tissue around the walls of the cavity with Papacárie Duo and a curette followed by the application of aPDT and deproteinisation with Papacárie Duo; group 2: selective removal of carious dentinal tissue around the walls of the cavity with a curette, followed by the application of aPDT and deproteinisation with a 5% sodium hypochlorite solution; group 3: selective removal of carious dentinal tissue using a curette. The selected teeth must have a carious lesion in the dentin and posteruptive enamel breakdown on one or more surfaces with an indication for clinical restorative treatment. The teeth will subsequently be restored using a mixed technique with resin-modified glass ionomer cement and bulk-fill composite resin. The data will be submitted to descriptive statistical analysis. Associations with age and sex will be tested using either the χ2 test or Fisher's exact test. Pearson's correlation coefficients will be calculated to determine the strength of correlations between variables. Comparisons of the microbiological results (colony-forming units) will be performed using analysis of variance and the Kruskal-Wallis test. Kaplan-Meier survival analysis will be performed to assess the performance of the restorations. ETHICS AND DISSEMINATION: This protocol has been approved by the Human Research Ethics Committee of Nove de Julho University (certificate number: 61027522.0.0000.5511/approval date: 23 August 2022). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05443035.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats.

Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. OBJECTIVE: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. METHODOLOGY: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). RESULTS: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. CONCLUSION: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial.

OBJECTIVE: To evaluate the influence of fluoride varnish (FV) therapies or resin infiltration (RI) to maintain the structural integrity of Molar Incisor Hypomineralization (MIH) -affected teeth. METHODS: Fifty-one children aged 6-12 years with at least one incisor and one first permanent molar with yellow/brown MIH opacities were included. Patients were randomly allocated into three groups: FV - Fluoride Varnish (Duraphat); FV+etch - Fluoride Varnish (Duraphat) after enamel etching with 37% phosphoric acid; or RI - Resin Infiltration system (Icon). Opacities were monitored for 18 months. The primary outcome was the loss of integrity due to post-eruptive enamel breakdown (PEB). Covariables included sex, age, DMFT index, opacity colour, plaque index, number of MIH-affected teeth, and number of MIH-affected surfaces. Fisher's Exact was used to test the association of treatments with PEB, the Kaplan-Meyer method analysed the survival rates and Cox-regression determined which covariables would predict failure (α=0.05). RESULTS: From a total of 235 teeth, the PEB rate for RI (6.1%) was significantly lower (p<0.05) than FV (17.9%; OR 3.0, 95%CI 1.07, 8.48) and FV+etch (17.3%; OR 3.1, 95%CI 1.13, 8.73). DMFT index >3, brown opacities, cusp involvement, and age between 6-8 years predicted PEB (p<0.05). CONCLUSIONS: Resin infiltration positively influenced the structural integrity maintenance of MIH-affected teeth by decreasing the risk of enamel breakdown over18 months follow-up. Registry of Clinical Trials (RBR-8wwk3n). CLINICAL RELEVANCE: Resin infiltration proved to be a more efficacious intervention to maintain the structural integrity of MIH-affected teeth than fluoride varnish therapies.

Inheritance pattern of molar-incisor hypomineralization.

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.

Molar incisor hypomineralization: prevalence, severity and clinical consequences in Brazilian children.

BACKGROUND: The prevalence of molar incisor hypomineralization (MIH) varies considerably around the world; however, few studies have examined MIH in South American countries. OBJECTIVE: To evaluate the prevalence, severity, and clinical consequences of MIH in Brazilian children residing in rural and urban areas of the municipality of Botelhos, Minas Gerais, Brazil. METHODS: Children aged 6 to 12 years (n = 918) with all four-first permanent molars erupted had these teeth evaluated according to the European Academy of Paediatric Dentistry (EAPD) criteria. The examinations were conducted by two previously trained examiners, and the dental impact caused by MIH was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index (WHO). RESULTS: Molar incisor hypomineralization was present in 19.8% of the 918 children, with a higher prevalence in rural areas. The majority of the defects presented were demarcated opacities without post-eruptive structural loss, which has been considered as mild defects. Children with MIH had higher DMFT values. CONCLUSION: Despite the high prevalence of MIH, the severity of the defects was mild. The results indicate a positive association between MIH and the presence of dental caries.

The effect of amoxicillin on dental enamel development in vivo.

The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.

In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection.

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14-19, 2001). Similar sensitivity and higher specificity was found at D(2) (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D(3) threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

In vitro evaluation of the influence of air abrasion on detection of occlusal caries lesions in primary teeth.

PURPOSE: The purpose of this study was to assess the influence of cleaning pits and fissures with an aluminum oxide air abrasion system on the detection of occlusal caries in primary teeth using loser fluorescence (LF) and visual examination. METHODS: The sample comprised 65 pit and fissure sites on extracted primary teeth suspected to be carious. The sites were submitted to 2 visual examinations (examiner JAR) and 2 LF readings (examiner TMV). Next, the occlusal surfaces were air-abraded and re-examined thereafter using both methods. The teeth were sectioned, and the histological analysis of the sites with a stereoscopic magnifying lens at X32 magnification was used as the gold standard. RESULTS: Cohen's kappa statistic for LF and visual examination were, respectively, 0.282/0.884 before and 0.896/0.905 after air abrasion. LF showed a sensitivity of 0.28 increasing to 0.49 and a specificity of 0.50 increasing to 0.92. Visual examination showed sensitivity of 0.78 and specificity of 0.73. Both increased after air abrasion. CONCLUSION: The findings suggest that cleaning pits and fissures with aluminum oxide air abrasion increased the accuracy of LF and visual examination for detection of occlusal caries in primary teeth.

Effect of Rubber Dam Clamps on Demineralized Cervical Enamel of Permanent Teeth.

PURPOSE: To evaluate the effect of two molar clamps on artificially demineralized enamel of permanent teeth after three periods of isolation. METHODS: Twenty extracted third molars were immersed in a biological solution for development of artificial white spot lesions and then were equally divided into two groups according to the clamp being placed (Group G205: clamp no. 205; Group G26: clamp no. 26). The loss of fluorescence and lesion area of demineralized surface after each isolation were assessed by quantitative light-induced fluorescence. RESULTS: There were significant statistical differences in artificially induced white spot lesions after the second and third clamp placement with both clamps. There was also a significant difference in quantitative light-induced fluorescence readings between groups when molar clamps were placed for the third time. CONCLUSION: It is possible to lose dental structure when using rubber dam clamps on teeth with white spot lesions in the cervical enamel.

Primary tooth length determination in direct digital radiography: an in vivo study.

PURPOSE: The purpose of this in vivo study was to compare the accuracy of primary incisor length determined by direct digital radiography (straight-line measurement and grid superimposition) and measurement of the actual tooth length. METHODS: Twenty-two primary maxillary incisors that required extractions were selected from 3- to 5-year-old children. The teeth were radiographed with an intraoral sensor using the long cone technique and a sensor holder (30-cm focus-to-sensor distance). The exposure time was 0.3 seconds. Tooth length was estimated by using straight-line and grid measurements provided by the distance measurement feature of the Computed Dental Radiography digital dental imaging system. The actual tooth length was obtained by measuring the extracted tooth with a digital caliper. Data were analyzed statistically by Pearson's correlation coefficient and a paired t test. RESULTS: There were statistically significant differences (P=.007) between the 2 measurement techniques and between the actual tooth lengths and grid measurements. There was no statistically significant difference (P=38) between straight-line measurements and actual tooth lengths, showing that the straight-line measurements were more accurate. Underestimation of the actual tooth length, however, occurred in 45% of the straight-line measurements and in 73% of the grid measurements. CONCLUSION: It is possible to determine primary tooth length in digital radiographs using onscreen measurements with a reasonable degree of accuracy.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up.

The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6-8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher's exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Impact of the undergraduate clinical teaching-learning process on caries detection and treatment decision-making

Aim: The aim of this study was to evaluate caries diagnosis and treatment decisions made by undergraduate dental students based on ICDAS or Nyvad criteria. Methods: Twelve students analyzed 90 digital photographs of permanent teeth at different clinical stages of carious lesion development and chose among different treatments in three different assessments: when there was no knowledge of the criteria (described as "No knowledge (N)"; when there was theoretical knowledge of the criteria (described as "Theoretical knowledge (T)" and when there was theoretical knowledge, clinical experience about dental caries and the criteria (described as "Theoretical and clinical knowledge (TC)". For "T" and "TC" the students were randomized into two experimental groups ­ ICDAS or Nyvad (experimental units: 6 students/group). The reference standard was established cooperatively by two experienced researchers. Criteria performance was evaluated by sensitivity, specificity, AUC, and Kappa statistics. Treatment decision was described in percentage by contingency tables and Spearman's correlation with the reference standard. Results: The first assessment demonstrated a high percentage of operative treatment even for initial enamel lesions based on ICDAS criteria and treatment was proposed for both active and inactive lesions, according to the Nyvad criteria. In the second assessment, the students continued recommending treatments for initial or inactive lesions, but less frequently. In the third assessment, treatment decisions presented greater cohesion in relation to the assigned classification criterion. The criteria presented no differences between them in terms of diagnostic in the third assessment. Conclusion: Clinical experience may improve caries detection and treatment decisions with the use of ICDAS and Nyvad criteria

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.