Prevalence of erosive tooth wear in risk group patients: systematic review.

OBJECTIVE: This systematic review investigates the prevalence of erosive tooth wear (ETW) in individuals classified as risk groups (gastroesophageal reflux disease, eating disorders, special diets, acidic beverage, drugs and alcohol, legal drugs and medications, and occupational or sports). MATERIALS AND METHODS: The research was conducted in nine databases (PubMed/MEDLINE, Embase, Cochrane Library, LILACS/BVS, SciELO, Scopus, Science Direct, Open Grey, and Web of Science) up to April 2024 (PROSPERO CRD42021270150), along with a manual search of grey literature. Observational studies involving children and adults from these previously mentioned risk groups, which provided data on ETW prevalence, were included without date or language restrictions. The methodological quality of studies was evaluated using the Joanna Briggs Institute's Prevalence Data Critical Appraisal Tool. General and subgroup data were meta-analyzed using a random-effects model. RESULTS: Overall, 4403 studies were retrieved, out of which 148 met the inclusion criteria. Each risk group showed higher prevalences of ETW in these patients in general and subgroup analysis; although subgroup analysis was not possible for all risk groups due to the heterogeneity of the indices found. CONCLUSIONS: The Legal drugs and Medications risk group showed lower overall prevalence values (30%), while the Drugs and Alcohol risk group obtained higher values (67%). Prevalence rates for other groups were: Gastroesophageal reflux disease (54.1%), Eating Disorders (65%), Special Diets (65.9%), Acidic Beverages (40%), Occupational and Sports (51%). CLINICAL RELEVANCE: This systematic review highlights that risk groups are indeed at significant risk for the development of ETW and greater preventive care and dental monitoring are needed.

Developmental Defects of Enamel.

Amelogenesis, the intricate process governing enamel formation, is susceptible to a range of genetic, systemic, and environmental influences, resulting in distinct developmental defects of enamel (DDE), such as molar incisor hypomineralisation (MIH), enamel hypoplasia, dental fluorosis, and amelogenesis imperfecta (AI). This chapter aims to provide a comprehensive overview of amelogenesis and DDE, establishing correlations between histopathological findings and clinical manifestations. MIH, a qualitative enamel defect, occurs during the mineralisation and maturation phases, affecting first permanent molars and eventually incisors. Diagnostic challenges in MIH arise from the disorder's unique features, including variable tooth involvement and severity, influenced by a complex interplay of genetic, systemic, and environmental factors. Enamel hypoplasia, a quantitative defect, manifests in any tooth during enamel matrix secretion. Etiological factors include local, systemic, environmental, and genetic influences, with variable enamel matrix abnormalities depending on the stage of amelogenesis when aggression occurred. Dental fluorosis, a toxicological concern from chronic and excessive fluoride exposure, affects ameloblasts and compromises crystal growth of the homologous teeth during enamel development. Lastly, AI, an inherited condition, encompasses diverse phenotypes in enamel development. AI phenotypes, whether hypoplastic or hypomineralised, entail mutations in genes, such as AMELX, ENAM, MMP20, KLK4, WDR72, FAM83H, C4ORF26, amelotin, GPR68, and ACPT. Diagnosing AI involves considering family history and clinical observation. In conclusion, navigating the intricacies of amelogenesis, from MIH to AI, underscores the critical importance of accurate diagnosis for proper clinical management of DDE.

Restorative Therapy of MIH-Affected Molars.

One fourth of teeth affected by molar incisor hypomineralisation (MIH) have required or will require treatment due to pain, sensitivity, or posteruptive breakdown. Restorative treatment becomes necessary in cases of severe MIH, characterized by posteruptive breakdown, which exhibits a wide range of clinical characteristics. Until approximately 20 years ago, all techniques, materials, and research were developed for treating caries lesions, not hypomineralisation. Research attempting to evaluate approaches to MIH treatment is recent and inconclusive. Therefore, there is still insufficient high-quality scientific evidence to establish a definitive clinical protocol for treating this condition. Recommendations based on best clinical practices can be provided rather than conclusions supported by a high level of evidence. To assist in clinical judgment regarding the best treatment strategy, eligible therapeutic options for restoring MIH-affected molars will be presented based on the strength and adhesive potential of the remaining hypomineralised enamel. The literature presents options for restorative materials ranging from direct alternatives such as glass ionomer cement and resin composite, through prefabricated devices, such as stainless-steel crowns and orthobands, to indirect restoration alternatives. However, it is essential to understand the indications of each restorative alternative and to know the restorative techniques, many of which are specifically developed to mitigate the difficulties encountered with the use of conventional techniques. Emphasis will be placed on the importance of adopting a personalized approach to restorative decision-making, considering the philosophy of minimal intervention dentistry and potential benefits for the patient's well-being and the family's needs.

Orthodontic Analysis behind the Extraction of Hypomineralised First Molars.

This chapter will discuss the orthodontic perspective of extractions of compromised first permanent molars (cFPMs) due to hypomineralisation. The context behind the diagnosis of a poor prognosis of cFPM that would support the planning of extractions will be presented. In addition, the ideal timing for interceptive extraction of cFPM as well as the favorable and unfavorable orthodontic scenarios for extractions in the permanent dentition will be discussed.

Re-Establishing the Esthetics of Incisors in Patients with Molar Incisor Hypomineralisation.

The awareness of molar incisor hypomineralisation (MIH) has led to its increased clinical detection, consequently drawing more attention to its associated complications. This text offers an overview of the esthetic management of anterior teeth affected by MIH, a condition characterized by enamel defects that present significant cosmetic challenges. The focus is on the clinical presentation of MIH characteristics, considering the depth of lesions and the clinical aspects, and the treatment protocols available, despite a lack of extensive scientific evidence. To the best of the current scientific knowledge, the text evaluates the potential of minimally invasive procedures, as well as the use of traditional composite resin techniques and their possible combinations, highlighting the critical role of esthetic considerations for the impacted anterior teeth. The chapter is augmented with five illustrative clinical cases that display the practical application of these treatment approaches. These examples articulate the clinical decision-making process and personalized restorative strategies, aiming to balance function with enhanced esthetic results. The described cases act as a roadmap for clinicians tackling the complexities of MIH treatment in the context of limited empirical evidence, providing insights into achieving both satisfactory and esthetically pleasing outcomes for patients suffering from this condition.

Molar Incisor Hypomineralisation: A Recent Condition or a New Perception?

The condition known as molar incisor hypomineralisation (MIH) has been featured in the dental literature for some time. However, the condition itself, characterized by demarcated opacities, had been observed and documented in various forms before the official terminology was coined. The awareness and understanding of MIH have increased over the years, and there has been ongoing research to explore its prevalence, etiology, clinical implications, care, and treatment. In summary, MIH is not a recent condition, but the terminology and recognition of this dental phenomenon have been refined and formalized in the relatively recent past. This chapter reflects on our clinical experience, juxtaposing it with information from scientific literature and personal insights, as well as identifying gaps in understanding this enamel defect. Furthermore, another aim was to foster contemplation for potential research advancements in the MIH field.

Is It Possible to Remineralise Hypomineralised Enamel Lesions in Patients with Molar Incisor Hypomineralisation?

Molar incisor hypomineralisation (MIH) is characterized with reduced enamel mineral quantity, especially in the calcium and phosphate content, with increases in the carbonate and protein contents. Albumin is the main protein that accumulates pre-eruptively, leading to defective initiation of mineralisation. Other oral-fluid proteins are found in cases of posteruptive enamel surface breakdown. Most of the lesions extend through the full thickness of enamel. Due to the lower mineral quantity and increased carbon and protein content, MIH teeth are more prone to fractures once exposed to mastication. In addition, susceptibility to dental caries is increased and hypersensitivity is common in MIH patients. For these reasons, MIH-affected teeth might benefit from exposure to remineralising agents that will decrease caries susceptibility and reduce sensitivity. Several in vitro, in situ, and in vivo studies have shown that improving the mineralisation of MIH teeth after eruption is possible, especially at the surface. However, complete resolution is difficult due to the depth/thickness of these lesions. In fact, the process is similar to posteruptive maturation. Thus, this nomenclature should be used instead of remineralisation. The evidence available so far indicates that among the several available remineralising agents, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream and fluoride (F) varnish show the best results and are equally effective in remineralising MIH-affected teeth. Fluoride varnish demands no patient adherence, while CPP-ACP cream can be applied at home. However, it is important to consider that fluoride varnish is generally more economical than CPP-ACP cream. Consequently, the choice between these agents can be tailored to the patient's specific requirements.

Cost-Effectiveness of Managing MIH Teeth.

Numerous therapeutic approaches are available for managing molar incisor hypomineralisation (MIH); however, the cost-effectiveness of these strategies is underexplored. Economic evaluations are crucial for determining the optimal treatment approach to individual patients' requirements. We systematically reviewed the literature on the topic to have a more comprehensive discussion about these issues. Systematic searches were carried out. After a two-stage selection, 11 studies were included for synthesis. These studies could be divided into three groups according to the type of information given on costs: assumptions or deductions based on the literature (n = 6), cost collection on the available sources (n = 3), and cost-effectiveness evaluations (n = 2). The economic evidence on MIH management is still scarce and incipient. However, some important findings were produced for this evidence synthesis. A database of costs valuable in different contexts for therapeutic approaches related to MIH and its consequences was created. Furthermore, compiling and digesting the evidence on the cost-effectiveness of different approaches for managing severe MIH cases points out possible directions to be considered in decision-making that should consider these economic outcomes in different contexts and their powers of generalizability and also other aspects of evidence-based practice (e.g., professional and patients' preferences). Finally, there is an imminent need for economic evaluations focused on investigating the potential efficiency of preventive approaches for managing minor-compromised MIH teeth to postpone/avoid the severe consequences, which are more critical, complex, and costly to treat.

Three-Point Checklist Dermoscopy for Melanoma Screening: Experience in Medical Students New to Dermatology.

INTRODUCTION: Early detection of melanoma and optimal referral to the specialist starts in primary care. Medical education is usually deficient in training general physicians in early detection and risk management for most skin malignancies. A three-point dermoscopy checklist is used as a screening tool for differentiating malignant and benign pigmented lesions in non-expert clinicians using dermoscopy. OBJECTIVES: To evaluate the impact of brief medical training on the three-point dermoscopy algorithm in third-year medical students new to dermatology and to determine the levels of sensitivity and specificity to differentiate malignant and benign pigmented lesions. METHODS: Optional dermoscopy lecture for third-year medical students new to dermatology in the context of general medical semiology courses, with case discussion and evaluation of 50 dermoscopy cases (25 benign and 25 malignant). Students were asked to classify malignant versus benign pathology based on the three-point dermoscopy algorithm discussed. Sensitivity, specificity, and predictive values were calculated according to the students' responses. RESULTS: Sixty-five students provided 3250 responses. Malignant pathology was misclassified as benign in 154 responses, while benign pathology was misclassified as malignant in 668 responses. Sensitivity and specificity for differentiating malignant lesions were 89.70% and 61.99%, respectively. Moderate interobserver agreement was found (Kappa value = 0.50; [CI: 0.47-0.54]). CONCLUSION: When evaluating melanocytic lesions, the focus of primary healthcare and general medical education should emphasize the correct determination of malignant or benign pathology. Teaching the three-point dermoscopy rule to medical students new to dermatology yields satisfactory levels of sensitivity and specificity, comparable to general physicians.

Can the combination of proanthocyanidin and vitamin E or palm oil effectively protect enamel against in vitro erosive and abrasive challenges?

OBJECTIVES: This study aimed to assess the effect of proanthocyanidin, palm oil and vitamin E against erosive and erosive+abrasive challenges in vitro after enamel pellicle formation in situ. METHODOLOGY: Bovine enamel blocks (n=84) were obtained and divided into the following treatment groups: negative control (NC) - deionized water; positive control (PC) - SnCl2/NaF/AmF-containing solution; palm oil (PO); 2% proanthocyanidin (P2); vitamin E (VitE); 2% proanthocyanidin+palm oil (P2PO); and 2% proanthocyanidin+vitamin E (P2VitE). For 5 days, one half of the sample from each group was subjected to erosion and the other half was subjected to erosion+abrasion. The acquired enamel pellicle (AEP) was pre-formed in situ for 30 minutes. The specimens were then treated in vitro with solutions (500 µl, 30s for each group). Subsequently, the blocks were left in the oral cavity for another hour to obtain the modified AEP. The blocks were immersed in 0.5% citric acid (pH=2.5) for 90s, 4×/day. AEP formation and treatment were carried out before the first and third erosive challenges, and after these challenges, abrasive cycles (15s) were performed on half of the samples. Enamel wear was quantified by profilometry and data were analyzed by two-way ANOVA and Tukey's test (p<0.05). RESULTS: All groups showed higher wear when exposed to erosion+abrasion than when exposed to erosion alone (p=0.0001). PO, P2VitE, P2, and P2PO showed enamel wear similar to the PC group, but only PC, PO and P2VitE differed from the NC group. The other groups behaved similarly to NC. CONCLUSION: It was concluded that the combination of proanthocyanidin and vitamin E was effective in reducing wear in the face of in vitro erosive and erosive+abrasive challenges.

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries.

OBJECTIVE: Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. METHODS: A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. RESULTS: When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167). CONCLUSION: Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. CLINICAL RELEVANCE: The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial.

INTRODUCTION: Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method. MATERIALS AND METHODS: This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05). RESULTS: There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570). CONCLUSION: The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.

Are S-PRG composites able to resist against erosive and abrasive challenges and protect surrounding enamel in situ?

OBJECTIVES: This study evaluated the resistance of S-PRG (Surface Pre-Reacted Glass-ionomer) composites and other restorative materials against erosive and abrasive challenges and their protective effect on enamel adjacent to the restorations. MATERIALS AND METHODS: Bovine enamel blocks were prepared and randomized into 12 groups, including 6 types of material, each of them subjected to erosion_e or erosion+abrasion_ea: Beautifil II (S-PRG); Beautifil Bulk Restorative (S-PRG); Filtek Z250 XT; Filtek Bulk Fill; EQUIA Forte; Riva Light Cure. Cavities were prepared in the middle of enamel blocks and restored with the materials. Initial profiling measurement was performed on the material and on adjacent enamel (100, 200, 300, 600 and 700 µm from the restoration margin). Palatal intraoral appliances with the restored enamel blocks were used by the volunteers (n = 10). During 5 days appliances were immersed in 2.5 % citric acid for 2 min; 6 × /day (erosion_e). For ea condition, blocks were brushed for 1 min after each acid immersion. Final profile assessment was performed. Data were analysed by two and three way ANOVA followed by Tukey's test (p < 0.05). RESULTS: Material wear: Riva Light Cure showed the highest wear followed by EQUIA Forte and then all resin composites, including the ones with S-PRG (p = 0.000). Enamel wear: there was significant interaction among type of restorative material, wear condition and distance (p = 0.014), enamel around materials showed similar wear (p = 0.983) and the enamel subjected to ea exhibited highest wear (p = 0.000). CONCLUSION: SPRG based composites showed resistance against erosive and abrasive challenges but were not able to protect enamel adjacent to the restorations. CLINICAL SIGNIFICANCE: S-PRG composites exhibit resistance to material wear comparable to resin composites. However, they have shown an inability to effectively protect the adjacent enamel under in situ erosive-abrasive conditions, despite the presence of mineral-loss-preventing ions surrounding materials.

Is Cavity Lining Really Necessary After Selective Caries Removal in Primary Teeth?

ABSTRACT Objective: To evaluate the clinical and radiographic response of pulp-dentin complex after selective caries removal with or without pulp lining in primary teeth. Material and Methods: Twenty-four primary molars with deep occlusal caries lesions and without pulpal alterations were selected from children, both genders, aged between 5 and 9 years old. After selective caries removal, the teeth were divided into three groups: without cavity liner (Group I), calcium hydroxide cement - CH (Group II), and Mineral trioxide aggregate - MTA (Group III). The final restoration was performed with resin-modified glass ionomer cement. Clinical and radiographic assessments were conducted at 6-month follow-up. The Kappa test determined intraexaminer reliability. Fisher's exact test evaluated intergroup comparisons (p<0.05). Results: All teeth showed clinical and radiographic success at the 6-month follow-up without statistically significant differences (p>0.05). Conclusion: Selective caries removal without cavity lining was acceptable for deep caries lesions in primary teeth.

Can the combination of proanthocyanidin and vitamin E or palm oil effectively protect enamel against in vitro erosive and abrasive challenges?

Abstract Objectives This study aimed to assess the effect of proanthocyanidin, palm oil and vitamin E against erosive and erosive+abrasive challenges in vitro after enamel pellicle formation in situ. Methodology Bovine enamel blocks (n=84) were obtained and divided into the following treatment groups: negative control (NC) - deionized water; positive control (PC) - SnCl2/NaF/AmF-containing solution; palm oil (PO); 2% proanthocyanidin (P2); vitamin E (VitE); 2% proanthocyanidin+palm oil (P2PO); and 2% proanthocyanidin+vitamin E (P2VitE). For 5 days, one half of the sample from each group was subjected to erosion and the other half was subjected to erosion+abrasion. The acquired enamel pellicle (AEP) was pre-formed in situ for 30 minutes. The specimens were then treated in vitro with solutions (500 µl, 30s for each group). Subsequently, the blocks were left in the oral cavity for another hour to obtain the modified AEP. The blocks were immersed in 0.5% citric acid (pH=2.5) for 90s, 4×/day. AEP formation and treatment were carried out before the first and third erosive challenges, and after these challenges, abrasive cycles (15s) were performed on half of the samples. Enamel wear was quantified by profilometry and data were analyzed by two-way ANOVA and Tukey's test (p<0.05). Results All groups showed higher wear when exposed to erosion+abrasion than when exposed to erosion alone (p=0.0001). PO, P2VitE, P2, and P2PO showed enamel wear similar to the PC group, but only PC, PO and P2VitE differed from the NC group. The other groups behaved similarly to NC. Conclusion It was concluded that the combination of proanthocyanidin and vitamin E was effective in reducing wear in the face of in vitro erosive and erosive+abrasive challenges.

Erosive Tooth Wear in Subjects with Normal Occlusion: A Pioneering Longitudinal Study up to the Age of 60.

The aim of this study was to assess the erosive tooth wear (ETW) at early and mature adulthood in subjects with natural normal occlusion. The sample consisted of 23 untreated subjects with normal occlusion. Dental models were taken longitudinally from the same subjects at 13 (T0), 17 (T1) and 60.9 years of age (T2) at a university. Evaluation of ETW was performed using a modified Basic Erosive Wear Examination (BEWE) index. Interphase changes were evaluated using Friedman and Dunn's test. Ordinal logistic regression was used to assess the influence of sex, dental arch, tooth and dental surfaces on the erosive tooth wear. Linear regression was used to evaluate whether the ETW degree at T1 could discriminate the degree of ETW at T2. The significance level adopted was 5%. ETW showed a significant increase with aging. The median ETW index at T0, T1 and T2 was 2, 4 and 7, respectively. ETW was greater in males in the incisors and canines and on the incisal/occlusal and lingual tooth surfaces. No significant differences were found between the maxillary and mandibular arches. Subjects with severe ETW at mature adulthood had greater tooth wear at age 17. In conclusion, ETW significantly increased during aging in subjects with normal occlusion. The greater the degree of tooth wear at early adulthood, the greater the tooth wear at mature adulthood. Preventive care should be recommended during early adulthood in patients demonstrating erosive tooth wear in order to avoid worsening with aging.

Proteomic analysis of stimulated saliva in gastroesophageal reflux disease patients with and without erosive tooth wear: Observational study.

OBJECTIVE: To evaluate the difference in the proteomic profile of stimulated saliva in patients with gastroesophageal reflux disease (GERD) with (GE) and without (GNE) erosive tooth wear (ETW), regarding both human and bacterial proteins. METHODS: Stimulated saliva (SS) was collected from 16 patients (8/group). Samples were centrifuged at 4.500 g for 15 min under refrigeration to remove all debris. The supernatant from each saliva sample was taken and frozen at -80 °C. After extracting the proteins, they were submitted to reverse phase liquid chromatography and mass spectrometry (nLC-ESI-MS/MS). Label-free proteomic quantification was performed using Protein Lynx Global Service (PLGS) software (p < 0.05) for human and bacterial proteins. RESULTS: In total, 67 human proteins were common for GNE and GE groups. GNE group presented, compared to GE group, increase in proteins that confer antimicrobial and acid resistant properties, such as cystatins, histatin and immunoglobulins. However, GNE group had a marked decrease in subunits of hemoglobin (α, ß and delta). Regarding bacterial proteins, for SS, 7 and 10 unique proteins were identified in the GE and GNE groups, respectively. They are related to protein synthesis and energy metabolism and interact with human proteins typically found in saliva and supramolecular complexes of the acquired pellicle. CONCLUSIONS: Our data indicate that the stimulation of the salivary flow increases acid resistant and antimicrobial proteins in saliva, which might protect against ETW. CLINICAL SIGNIFICANCE: This pioneer study showed important differences in the human and bacterial proteome of SS in patients with GERD with or without ETW.

Comparison between two molar incisor hypomineralization detection criteria in epidemiological surveys.

BACKGROUND: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. AIM: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH-Severity Scoring System (MIH-SSS) in classifying and diagnosing MIH. DESIGN: This cross-sectional study assessed the indices in a homogeneous group of 680 6- to 10-year-old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. RESULTS: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH-SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH-SSS (chi-squared test; p < .01). The MIH-SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p < .05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. CONCLUSION: All systems effectively diagnosed MIH and its characteristics.

Preventive effect of cranberry gel on dentin submitted to erosion

Aims: Considering that Cranberry's components might inhibit dentin metalloproteinases exposed to erosive agents, the aim of this study was to evaluate in situeffect of a Cranberry gel application on dentin before an erosive challenge.Materials and methods: This crossover double-blinded study was performed in 2 phases of 5 days each, with 10 healthy volunteers who wore 2 palatal devices (1 for each phase) with 4 dentin specimens (2 specimens for each group). The groups under study were:First Phase: G1 -Erosivechallenge (Coca-cola®) over dentin without any previous treatment (1st negative control group); G2 -Erosive challenge over dentin previously treated with Cranberry gel (test group); and Second Phase: G3 -Erosive challenge over dentin previously treated with a gel without any active principle (2ndnegative control group); G4 -Erosive challenge over dentin previously treated with 0.12% Chlorhexidine gel (positive control group). Each device was immersed into the acid beverage, 3 times daily for 5 minutes during 5 days. Profilometry (µm) was used to quantify the dentin wear. Data were analyzed by Repeated Measures Analysis of Variance followed by Fisher's test (p<0.05).Results: Data (G1: 4.98 ± 1.36a; G2: 3.29 ± 1.16b; G3: 4.38 ± 1.19a; G4: 3.32 ± 1.55b) showed no statistical difference between G1 and G3. There was also no difference between G2 and G4. However, G2 and G4 presented lower wear when compared to G1 and G3, and this difference was statistically significant. Conclusion: The results of this studysuggest a significant efficacy of Cranberry gel in preventing wear of dentin subjected to dental erosion.