Influence of customized therapy for molar incisor hypomineralization on children's oral hygiene and quality of life.

OBJECTIVE: The aim of this clinical follow-up study was to demonstrate the effects of different therapeutic strategies for hypomineralized teeth on patients' oral health. The treatment results were characterized by changes in the extent of hypersensitivity and plaque accumulation, as well as reductions in nutritional restrictions. MATERIAL AND METHODS: The impacts of therapy, including the use of fluoride varnish, fissure sealants, fillings, and stainless steel crowns, were evaluated in 78 children (mean age 8.5 years). We followed recommendations according to the Molar Incisor Hypomineralisation Treatment Need Index for customized treatment. The Quigley Hein Index, the Schiff Cold Air Sensitivity Scale, Wong-Baker Faces Scale, and dietary-limiting parameters were assessed before and after therapy for comparison. RESULTS: Plaque accumulation and hypersensitivity decreased after completion of therapy. The improvements were greater for individual teeth (Quigley Hein Index for teeth treated with stainless steel crowns from 4.19 to 2.54) than for those of the whole dentition (high-severity category from 2.67 to 2.20). Problems with food intake were minimized via therapy, with the greatest influence observed for patients who were also in the high-severity category. CONCLUSIONS: Therapy for affected teeth in children has positive effects on oral health and quality of life.

Hipomineralização molar- incisivo: percepção estética de crianças/adolescentes e de seus responsáveis / Molar-incisive hypomineralization: aesthetic perception of children / adolescents and their caregivers

O objetivo do presente trabalho foi avaliar a percepção estética de pacientes com hipomineralização molar-incisivo (HMI) e de seus responsáveis, bem como verificar o possível impacto da HMI em sua condição psicossocial antes e depois de seu tratamento. Além disso, verificou-se também uma possível correlação entre cárie dentária e HMI. Para este fim, foram avaliadas 56 crianças/adolescentes com idades entre 7 e 14 anos, divididas em dois grupos: grupo caso (crianças portadoras de HMI n=28) e grupo controle (crianças sem HMI n=28), além de seus responsáveis. Os critérios de exclusão foram ausência de curso de alfabetização, pacientes com comprometimento sistêmico e/ou cognitivo, com história de trauma dentário e aqueles em tratamento ortodôntico. A coleta de dados foi realizada por um único examinador treinado e calibrado (teste Kappa=0,88) através de exame clínico e aplicação de questionários. Na avaliação da percepção estética foi utilizado o questionário The Child and Parent's Questionnaire of Teeth Appearance devidamente validado e adaptado ao contexto brasileiro. Esse instrumento compreende questões de ordem física, psicológica e social, além das percepções sobre aparência (manchamento, cor, condição, alinhamento e saúde dos dentes). As opções de resposta foram em forma de múltipla escolha, apresentadas por uma escala de graduação variando da melhor condição (0) a pior condição (4). Além disso, os responsáveis responderam a um questionário semi-estruturado contendo dados pessoais, renda familiar e o nível de escolaridade dos pais. Para o diagnóstico do grau de severidade de HMI foi utilizado o critério da EADP (European Academic of Paediatric Dentistry) (graus leve e severo). O índice utilizado para a experiência de cárie dentária foi o CPO-D (dente cariado, perdido e obturado). Foram aplicados os testes do Quiquadrado, o teste T- student, regressão logística e teste Correlação de Spearman com o nível de significância de 5%. O gênero predominante nos pacientes foi o masculino (n = 35; 62,5%) e nos responsáveis, o feminino (n = 49; 87,5%). O nível sócio econômico, sexo e etnia não foram associados à HMI (p=0,77, p=0,41 p= 1,0, respectivamente). Em relação à severidade da HMI, 64,3% (n= 18) das crianças apresentaram grau leve. As crianças com HMI apresentaram uma insatisfação com as manchas em seus dentes (p=0,01). Porém não houve uma diferença estatisticamente significativa nas ordens física, psicológica e social (p = 0,17) entre as crianças. A HMI foi percebida pelos responsáveis (25,07 ±3,72), impactando sua condição psicossocial (p=0,03). Após o tratamento da HMI, houve uma melhora na percepção estética nas crianças (1,29±0,43) e nos seus responsáveis (2,43±1,0). Não houve correlação entre o CPOD e a HMI (p = 0,80). Conclui-se que a HMI foi percebida por crianças e responsáveis, impactando principalmente os responsáveis em relação às características físicas, psicológicas e sociais. O tratamento da HMI foi percebido por ambos, crianças e seus responsáveis, melhorando sua condição psicossocial. Não houve correlação entre a experiência de carie e HMI (AU)

The aim of the study was to determine patients and parent's aesthetic perception and psychological impact of molar incisor hypomineralization (MIH) before and after dental treatment. In addition, MIH was correlated with caries experience. The sample comprised 56 patients between 7 to 14 years old presenting MIH (case group) and without sing of MIH (control group), together with their parents. The exclusion criteria applied for both groups were illiterate patients and parents, patients with systemic involvement, dental trauma and under orthodontic treatment. Data collection was performed by a single calibrated examiner (Kappa test = 0.88) by clinical examination and questionnaires. The perception data used the Child and Parent's Questionnaire of Teeth Appearance. This instrument was validated and adapted to the Brazilian context and comprised questions about physical, psychological, and social conditions as well as the aspects of appearance, alignment and oral health. Answers could be given in the form of multiple choices presented on a grading scale, ranging from best condition (0) to worst condition (4). Besides, parents answered a semi-structured questionnaire containing personal data, family income, and parents' education. MIH was diagnosed by criteria of EAPD (European Academy of Pediatric Dentistry). Caries experience was assessed by DMFT (decayed, missed, filled, teeth). Chi-square, Student t and correlation tests and Binary logistic regression, were used with a significance level of 5%. The predominant gender in patients was male (n = 35; 62.5%) and most of parents were female (n = 49; 87.5%). The socioeconomic level, gender and ethnicity were not associated with MIH (p = 0.77, p = 0.41 p = 1.0, respectively). Regarding the severity of the MIH, 64.3% (n = 18) of the children had mild cases. There was no statistically significant difference in the physical, psychological and social orders (p = 0.17) in children. The MIH was perceived by parents (25.07 ± 3.72), impacting their psychosocial condition (p = 0.03). After treatment of the MIH, there was an improvement in the aesthetic perception of children (1.29±0.43) and their parents (2.43±1.0). Caries experience was not correlated to MIH (p= 0.80). We conclude that MIH was perceived by children and parents, impacting parents with regards to the physical, psychological and social aspects. The treatment of MIH was perceived by both children and their parents, improving their psychosocial condition. Caries was not correlated with MIH in this population (AU)

Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists.

INTRODUCTION: Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. METHODS: This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. RESULTS: All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). CONCLUSIONS: The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.