Risk factors associated with occlusal caries in first permanent molars in a school program: longitudinal study

Aim: Evaluate the longitudinal status of dental caries in the occlusal surface of first permanent molars (FPM) and to identify risk factors for the progression to cavitated caries lesions in a school oral health program. Methods: Children who were enrolled in the program between September 2017 and October 2019, 5 to 10 years-old, presenting the four FPM were included. Four calibrated examiners assessed dental caries according to Nyvad criteria. Descriptive analysis included frequency, mean, and standard deviation calculations. Chi-square test was used in the bivariate analysis and, logistic regression adjusted for cluster effect was used to identify significant risk factors for cavity among the following independent variables: gender, age in the baseline, deft, upper/lower molar, initial caries score, Molar Incisor Hypomineralization (MIH), fluorosis, occlusal sealing. Odds ratio (OR) and respective confidence intervals (CI) are presented. Results: From 174 children enrolled in the program between 2017/2019, 120 were reevaluated in 2022. Eleven (2.6%) FPM in 11 children (9.2%) presented cavitated caries in the follow up examination. Significant risk factors for cavity were caries experience in the primary teeth (OR = 5.59; CI: 1.4 ­ 22.3) and the presence of MIH (OR = 5.33; CI: 1.6 ­ 18.1). Most of the active lesions in the follow up were considered active in the baseline examination. Conclusions: The progression to cavity was relatively low, significantly influenced by past caries experience and MIH

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis.

This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis

Abstract This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial.

OBJECTIVES: The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively. METHODS: Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis. RESULTS: In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01). CONCLUSION: Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes. CLINICAL SIGNIFICANCE: Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors.

Are yellow-brownish opacities in hypomineralized teeth more prone to breakage than white-creamy ones? A systematic review.

OBJETIVE: To evaluate all the available evidence assessing if in hypomineralized teeth, yellow-brownish opacities are more prone to post-eruptive breakdown (PEB) compared to white-creamy opacities. MATERIALS AND METHODS: Observational studies that evaluated the occurrence of PEB in hypomineralized teeth were considered for inclusion. Electronic searches were performed up to January 2022 in MedLine, LILACS, BBO, Cochrane Library, Web of Science, Scopus, and EMBASE. Neither publication date nor language restrictions were imposed to the searches. Two researchers independently performed the study selection, data extraction, and quality assessment of the included studies according to the Newcastle-Ottawa Scale (NOS). Datasets from studies were grouped for narrative synthesis based on the severity of the PEB (enamel or dentin), type of tooth (molar or incisor), unit of analysis (subject or tooth or tooth surface), and follow-up period (in months). The certainty of evidence was evaluated using the GRADE approach. RESULTS: Nine studies were included, five cohort and three cross-sectional. All studies assessed the opacities and PEB by visual examination and diagnosed MIH according to EAPD criteria. In the cohort studies, considering all follow-up periods (ranging from 6 to 36 months), dark opacities fractured more than light opacities, at both enamel and enamel/dentin levels, and molars fractured more than incisors. In two out of three cross-sectional studies, dark opacities also fractured more than light opacities, but the deep of the PEB (enamel or dentin breakdown) or the type of tooth (molar or incisor) was not considered in the analysis. CONCLUSION: Although it seems plausible to state that darker demarcated opacities in MIH patients broke more often than light ones, based on this systematic review of the literature, the certainty of the available evidence about this association is still very low. CLINICAL RELEVANCE: More reliable and valid research is still necessary to support any future recommendation that MIH children who present yellow-brownish opacities should be monitored at shorter intervals compared to those who present only white-creamy opacities.

Prevalence and Severity of Molar Incisor Hypomineralization in Brazilian Children.

Purpose: The purpose of this study was to evaluate the prevalence, severity, and distribution of molar incisor hypomineralization (MIH) and its association with socioeconomic characteristics among eight-year-old students from public schools in Petrópolis, Rio de Janeiro, Brazil. Methods: This cross-sectional study evaluated 450 eight-year-old Brazilian children. A questionnaire was used to assess socioeconomic factors (family income, maternal education, and person per household). MIH was diagnosed based on European Academy of Paediatric Dentistry criteria. The severity of MIH was evaluated at patient and tooth levels. The examinations were conducted in school environments. Descriptive analysis, chi-square, Fisher's exact, and Kruskal-Wallis tests were performed. Results: The prevalence of MIH was 28.7 percent. The average of affected molars and incisors was 2.25 (standard deviation [SD] equals 1.03) and 0.84 (1.22 SD). The maxillary molars were the most affected, but mandibular molars showed greater severity. The majority of MIH-children had white-creamy opacities (51.9 percent). There was no association between MIH and socioeconomic factors. MIH was more prevalent in boys (P=0.025). The number of incisors with MIH rose with the increasing number of affected molars (P=0.02). A significant association between severity and the mean number of affected molars was observed (P=0.004). Conclusions: The prevalence of molar incisor hypomineralization was 28.7 percent. MIH severity at the individual level was significantly associated with the number of affected teeth and the occurrence of affected incisors.

Esthetic rehabilitation in primary and permanent successors incisors in a child with conoidal and absence teeth: a case report

Objective: To show the aesthetic treatment performed in deciduous incisors and in permanent successors in a child with congenital dental abnormalities (conoid and missing teeth), which associated with bone disproportion of the middle third of the face led to a suspicious diagnosis of ectodermal dysplasia. Case report: This report was written following the CARE Statement. A 6-year-old girl attended the Pediatric Dental Clinic complaining about bullying due to appearance her teeth. The reanatomization of the conoid-shaped deciduous incisors was done with direct composite resin using preformed acetate crowns. After 15 months, the deciduous incisors had exfoliated and the permanent incisors erupted also with a conoid shape. For aesthetic rehabilitation, direct composite restorations were performed using the incremental technique guided by a silicone matrix made based on the diagnostic wax-up. Conclusion: In the follow-up, the patient and guardians reported satisfaction with appearance of her smile and an increased self-esteem. The case remains under follow-up and future planning will include orthodontics and prosthodontics.

Objetivo: Mostrar o tratamento estético realizado em incisivos decíduos e em seus sucessores permanentes em uma criança com anomalias dentárias congênitas (dentes conoides e ausentes), que associado a desproporção óssea do terço médio da face levaram a um diagnóstico suspeito de displasia ectodérmica. Relato de caso: Este relato foi redigido seguindo o CARE Statement. Menina de 6 anos de idade compareceu à Clínica de Odontopediatria com queixa de bullying devido à aparência de seus dentes. A reanatomização dos incisivos decíduos conoides foi feita com coroas de acetato pré-formadas e resina composta direta. Após 15 meses, os incisivos decíduos esfoliaram e os incisivos permanentes irromperam também com formato conoide. Para a reabilitação estética, foram realizadas restaurações diretas com resina composta pela técnica incremental guiada por matriz de silicone confeccionada a partir do enceramento diagnóstico. Conclusão: No seguimento, paciente e responsáveis relataram satisfação com a aparência do sorriso e aumento da autoestima. O caso continua em acompanhamento e o planejamento futuro incluirá ortodontia e prótese dentária.

Eficácia da técnica de infiltração em lesões cariosas proximais de molares decíduos: ensaio clínico controlado randomizado com 24 meses de acompanhamento / Efficacy of the infiltration technique in carious lesions proximal de molares deciduous: controlled clinical trial randomized with 24 months of follow-up

O objetivo deste ensaio clínico controlado randomizado boca-dividida foi avaliar a eficácia da técnica micro-invasiva de infiltração de cárie em lesões cariosas proximais de molares decíduos após 12 e 24 meses do tratamento, através da análise radiográfica pareada. Cinquenta crianças de 5 a 9 anos, com pelo menos 2 lesões proximais não cavitadas e extensão radiográfica atingindo 1/2 do esmalte ou 1/3 externo da dentina foram selecionadas, alocadas em grupo teste (Infiltração de resina, Icon®, DMG, Hamburgo, Alemanha) e grupo controle (dentifrício fluoretado e fio dental) e tratadas em estudo prévio. Foram elegíveis para a amostra do presente estudo os 50 pacientes que receberam a intervenção terapêutica no estudo anterior. Semestralmente os pacientes eram chamados para reforço da instrução de higiene oral e novo exame clínico odontológico e anualmente, submetidos a exame radiográfico digital. A análise radiográfica foi feita por avaliador padrão-ouro cego à alocação dos dentes (teste e controle), e aos dados clínicos dos pacientes. As diferenças entre o grupo teste e o grupo controle, em relação à progressão de lesão cariosa, foram analisadas utilizando o teste McNemar com nível de significância de 0,05. Vinte e dois pacientes compareceram à consulta de 12 meses de acompanhamento, sendo somados aos 20 pacientes já avaliados no estudo prévio, totalizando assim a amostra de 42 pacientes (42/50). Clinicamente apenas 1 lesão controle progrediu para cavitação. Radiograficamente, 11,9% das lesões teste e 33.3% das lesões controle progrediram. Em 10 pacientes apenas a lesão controle progrediu, enquanto em 1 paciente progrediu apenas a lesão teste; em 4 pacientes progrediu tanto a lesão teste como a controle (p=0,012). Outros vinte e dois pacientes (22/38), compareceram à consulta de 24 meses de acompanhamento. Clinicamente 5 lesões cavitaram (2 do grupo teste e 3 do controle). Radiograficamente, 22,7% lesões do grupo teste e 50% lesões do grupo controle e progrediram. Em 6 pacientes apenas a lesão controle progrediu, enquanto em nenhum paciente progrediu apenas a lesão teste; em 5 pacientes progrediu tanto a lesão teste como a controle (p= 0,031). O padrão de higiene bucal não mudou ao longo das revisões. O risco de cárie do paciente não influenciou no desfecho do estudo (p>0,05). A eficácia terapêutica da infiltração de resina aos 12 e 24 meses foi de 21,4% e 27,3%, respectivamente. Não foram encontrados efeitos adversos relacionados a técnica de infiltração. Pode-se concluir que a técnica de infiltração de resina é um método micro-invasivo seguro, eficaz e viável para tratamento de molares decíduos. (AU)

The purpose of this randomized controlled trial split month was evaluate the efficacy of microinvasive caries infiltration technique in proximal carious lesions in primary molars after 12 and 24 months of treatment through paired radiographic analysis. Fifty children aged 5 to 9 years, with at least two non-cavitated proximal lesions and radiographic extension involving 1/2 of the enamel or outer 1/3 of dentin were included, allocated in test group (resin infltration, Icon®, DMG, Hamburg, Germany) and control group (fluoride toothpaste and dental floss) and treated in a previous study. The 50 patients who received the therapeutic intervention in the previous study were eligible for the study sample. Patients were asked twice a year to reinforce oral hygiene instruction and a new clinical dental examination and, annually, submitted to digital radiographic examination. The radiographic analysis was done by blind gold standard evaluator to the allocation of the teeth (test and control), and to the clinical data of the patients. The differences between the test group and the control group, in relation to the progression of carious lesion, were analyzed using the McNemar test with a significance level of 0.05. Twenty-two patients attended the 12-month follow-up visit, and were added to the 20 patients already evaluated in the previous study, thus totaling the sample of 42 patients (42/50). Clinically only 1 control lesion progressed to cavitation. Radiographically, 11.9% of the test lesions and 33.3% of the control lesions progressed. In 10 patients only the control lesion progressed, whereas in 1 patient only the test lesion progressed; In 4 patients progressed both the test and control lesions (p = 0.012). Another twenty-two patients (22/38) attended the 24-month follow-up visit. Clinically, 5 lesions cavitated (2 from the test group and 3 from the control group). Radiographically, 22.7% lesions of the test group and 50% lesions of the control group and progressed. In 6 patients only the control lesion progressed, whereas in no patient only the test lesion progressed; In 5 patients progressed both the test and control lesions (p = 0.031). The standard of oral hygiene did not change throughout the reviews. The caries risk of the patient did not influence the outcome of the study (p> 0.05). The therapeutic efficacy of resin infiltration at 12 and 24 months was 21.4% and 27.3%, respectively. No adverse effects were found related to the infiltration technique. It can be concluded that the resin infiltration technique is a safe, effective and viable micro-invasive method for the treatment of deciduous molars. (AU)