Molar-Incisor Hypomineralization: Prevalence Comparative Study in 6 Years of Interval.

The aim of this study was to evaluate the prevalence evolution rate of MIH (molar-incisor hypomineralization) after a 6-year period in Araraquara/SP, Brazil. This population-based study evaluated MIH in 545 schoolchildren (6-12 years of age) and other associated alterations, dental caries and dental fluorosis (DF). A semistructured questionnaire was sent to the schoolchildren's parents/guardians with the purpose of identifying the socioeconomic profile. Associations between MIH and the clinical characteristics were analyzed by the Poisson analysis of regression with robust variance, estimating the RPc (crude prevalence ratio) with CI 95%. The level of significance of 5% was adopted. The MIH prevalence in Araraquara/SP in 2016 was 14.3% (n = 78), and at this time, an increase of 2% was observed, in comparison with the data of the first prevalence study conducted in 2010 (12.3%). The mild degree compromise was the most prevalent diagnosis in the affected teeth (82.0%). Among children with MIH, the mean number of affected teeth was 2.78. Of the total number of children with MIH, 32.0% presented alterations in both first permanent molars and permanent incisors. There is no significant association between MIH and dental caries experience on permanent dentition (PRc = 1.141; CI 95% 0.709-1.835) or on primary dentition (PR c = 1.132; CI 95% 0.749-1.709). Children with MIH presented significantly less prevalence of dental fluorosis (PR c = 0.505; CI 95% 0.268-0.950). There is no association between MIH and monthly Brazilian minimal wage income (PR c = 1.130; CI 95% 0.655-1.949). It was concluded that the number of MIH cases had increased, revealing a greater need for defining the etiological factors and establishing a correct diagnosis to make it possible to institute early intervention.

Contribution of dentistry in the diagnosis of systemic disorders related to erosive tooth wear / Contribución de la odontología en diagnóstico de trastornos sistémicos relacionados con el desgaste dental erosive / Contribuição da odontologia no diagnóstico de distúrbios sistêmicos relacionados ao desgaste dentário erosivo

Abstract Erosive tooth wear (ETW) is the irreversible loss of dental hard tissue resulting from the chemical-mechanical process. The aim of the present case report was to present two clinical cases of patients affected by ETW arising from different etiological factors. The patients, of the male gender, 9 and 10 years of age presented to the pediatric dental clinic, for routine evaluation. On clinical exam, both patients had no caries lesions, but some lesions suggestive of ETW, which had aspects such as a translucent halo around the occlusal surface of teeth, in addition to "cupping" lesions - mainly in the cusp region, and loss of tooth enamel (by volume). The lesions were restricted to enamel, and the patients showed no dental hypersensitivity. From the dental clinical exam and anamnesis, the two patients were found to have similar tooth structure loss, with diagnosis of ETW. However, in one patient the etiology was extrinsic due to diet, and in the other, it was intrinsic due to gastroesophageal reflux disease (GERD). The latter patient was referred to a specialist for evaluation of the systemic condition, and GERD was diagnosed. It was concluded that dentists play an important role, as coadjuvant in the diagnosis of health problems related to ETW. Therefore, meticulous clinical exams must be performed to establish the correct diagnosis, because swift intervention in the clinical cases presented had a positive impact on halting the erosive process.

Resumen El desgaste dental erosivo corresponde a una pérdida irreversible de tejido duro dental resultante de un proceso químico-mecánico. Este artículo tuvo como objetivo presentar dos casos clínicos de pacientes afectados por desgaste erosivo con diferentes factores etiológicos. Pacientes varones, de 9 y 10 años, acudieron a la clínica dental de odontopediatría para evaluación de rutina. A la exploración clínica, ambos pacientes no presentaban lesiones cariosas y algunas lesiones sugestivas de erosion que presentaban aspectos como un halo translúcido alrededor de la superficie oclusal del diente, además de puntos de punción principalmente en la región cuspídea (lesiones en ventosa) y pérdida del volumen del esmalte dental. Las lesiones se restringieron al esmalte y los pacientes no presentaron hipersensibilidad dentaria. Del examen clínico odontológico y de la anamnesis se aprecia que los dos pacientes presentaban similar pérdida estructural, con diagnóstico de desgaste erosivo, pero un paciente tenía una etiología extrínseca, por alimentación y otro, intrínseco, por trastorno gastroesofágico (TGRE). El paciente fue derivado al especialista para evaluación de la condición sistémica y se diagnosticó la TGRE. Se concluye que el odontólogo tiene un papel importante, como coadyuvante en el diagnóstico de los trastornos de salud relacionados con el desgaste erosivo. Por tanto, se debe realizar un examen clínico minucioso para establecer el diagnóstico correcto, ya que la rápida intervención en los casos clínicos presentados, incidió positivamente en la parálisis del proceso de erosión.

Resumo O desgaste dentário erosivo corresponde a uma perda irreversível do tecido duro dentário resultante de um processo químico-mecânico. O presente artigo teve por objetivo apresentar dois casos clínicos de pacientes afetados pelo desgaste erosivo com fatores etiológicos distintos. Os pacientes do gênero masculino, com 09 e 10 anos, compareceram à clínica odontológica de odontopediatria para avaliação de rotina. Ao exame clínico, ambos os pacientes apresentavam ausência de lesão de cárie e algumas lesões sugestivas de erosão que apresentavam aspectos como halo translúcido ao redor da superfície oclusal do dente, além de pontos socavados principalmente na região de cúspide (lesões de "cupping") e perda do volume do esmalte dentário. As lesões estavam restritas ao esmalte e os pacientes não apresentavam hipersensibilidade dentária. A partir do exame clínico odontológico e anamese pode-se constatar que os dois pacientes apresentavam perdas estruturais semelhantes, com diagnóstico de desgaste erosivo, porém um paciente apresentava etiologia extrínseca, pela alimentação e outro, intrínseca, por distúrbio gastroesofágico (DGRE). O paciente foi encaminhado ao especialista para avaliação do quadro sistêmico, sendo diagnosticado o DGRE. Conclui-se que o cirurgião-dentista tem um papel importante, como coadjuvante no diagnóstico de distúrbios de saúde relacionados ao desgaste erosivo. Portanto, um exame clínico de maneira minuciosa deve ser realizado para estabelecer o diagnóstico correto, visto que, a rápida intervenção nos casos clínicos apresentados, impactaram de forma positiva na paralisação do processo erosivo.

Dental fluorosis severity in children 8-12 years old and associated factors.

The aim of this study was to determine the frequency and severity of dental fluorosis (DF) and the association between severity and risk factors. In a cross-sectional study, 8- to 12-year-old children, born in a Colombian district, were evaluated according to the Thylstrup and Fejerskov Index (TFI) by two calibrated examiners. Molar Incisor Hypomineralization (MIH) and dental caries (DC) were also evaluated. Ordinal logistic regression was applied (p<0.05). Risk factors and lifestyle factors were collected using a questionnaire answered by parents. DF was detected in 76 (98.7%) of the children (average of 18.4 ±1.81 permanent teeth affected). Grade TF2 was the most frequently observed (34.8%); TF5 was observed in all age groups; TF6- TF7 were observed in 12-year-olds. No association was found between DF severity and DC (Odds Ratio (OR)=1.35; 95%CI: 0.56-3.26) or MIH (OR=1.39; 95%CI: 0.43-4.46). DF severity was significantly associated with use of an indoor wood stove for food preparation (OR = 9.34; 95%CI: 1.11-78.57) and use of a pea-sized volume of toothpaste (OR = 27.42; 95%CI: 1.57-477.36). Prevalence of DC was 38.1% and prevalence of MIH was 14.4%. In this population, the frequency of DF was high and severity was associated with use of an indoor wood stove for food preparation and toothpaste amount used during childhood.

El objetivo de este estudio fue determinar la prevalencia y severidad de la Fluorosis Dental (FD) y la asociación de la severidad con factores de riesgo. Mediante un estudio transversal, niños (8-12 años-de-edad), nacidos en Ayapel (El Cedro-Colombia) fueron evaluados por 2 examinadores calibrados, según los criterios del índice de Thylstrup y Fejerskov (TFI) para FD. También se evaluaron la Hipomineralización molar-incisiva (HMI) y la caries dental (CD). Se aplicó un cuestionario de factores de riesgo y estilo de vida, a los padres/responsables de los niños. Se utilizó un modelo de regresión logística ordinal (p<0.05). Se encontró FD en 76 (98.7%) niños (con una media de dientes permanentes afectados de 18.4 ±1.81). La severidad categoría TF2 fue la más observada (34.8%) en los dientes evaluados. Las lesiones que presentan pérdida estructural moderada TF 6-7, fueron evidenciadas en el grupo de edad de 12 años. No se encontró asociación entre la severidad y la CD (OR=1.35; IC95%:0.56-3.26) o con HIM (OR=1.39; IC95%:0.43-4.46). Se encontró una asociación significativa con la severidad de la FD en los niños que utilizaban fogón de leña-interno para la preparación de los alimentos (OR=9.34; IC95%:1.11-78.57) y utilizaban un volumen de crema dental del tamaño de una alverja- pequeña (OR=27.42; IC95%:1.57-477.36). la prevalencia de CD fue 38.1% y de HMI fue 14.4%. La frecuencia de la FD fue alta y la severidad mostró correlación con la utilización de fogón de leña interno para la preparación de los alimentos y la cantidad de crema-dental utilizada.

Clinical changes in the severity of dental fluorosis: a longitudinal evaluation.

BACKGROUND: Dental fluorosis (DF) has been one of the most prevalent pediatric dental conditions associated with aesthetic concern and treatment needs. This study aimed to identify the longitudinal clinical change in the severity of DF in 8-12-year-old children and its association with gender, age, severity, and tooth type. METHODS: This observational study assessed the dental aspects of the 92 Colombian children in 2015 (mean age at beginning 9.71 years ± 1.23) and 2018 (mean age 13.69 years ± 1.41), from an area with high DF prevalence. DF was recorded in all permanent teeth by two calibrated examiners using the Thylstrup and Fejerskov Index (TFI). DF severity change (maximum-TFI-score) was analyzed with descriptive analysis at the tooth level. Associated factors were evaluated with the generalized linear model, binomial family, and logarithmic link function. RESULTS: TFI scores ranged between 1 (very mild) to 6 (severe), being score 2 (41.7%) the most prevalent. After three years, 29.6% of the teeth presented score reduction, 24.1%, increased and 46.3% did not change; the significant association was related to increasing of the basal TFI = 1 score (44.2%) (RR = 9.7; 95% CI 1.7-56.5; p = 0.01) and with canines, premolars and second-permanent-molars teeth group (RR = 3.3; 95% CI 1.9-5.6; p = 0.005). CONCLUSION: The present study based on clinical features about DF confirms the dynamic post-eruptive nature of this condition. After three years of follow-up, a considerable proportion of the teeth changed to a higher score. Furthermore, the canines, premolars, and second-permanent-molars showed a higher incidence of an increase in severity of TFI score.

Dental fluorosis severity in children 8-12 years old and associated factors / Severidad de fluorosis dental y factores asociados en niños de 8-12 años de edad

ABSTRACT The aim of this study was to determine the frequency and severity of dental fluorosis (DF) and the association between severity and risk factors. In a cross-sectional study, 8- to 12-year-old children, born in a Colombian district, were evaluated according to the Thylstrup and Fejerskov Index (TFI) by two calibrated examiners. Molar Incisor Hypomineralization (MIH) and dental caries (DC) were also evaluated. Ordinal logistic regression was applied (p<0.05). Risk factors and lifestyle factors were collected using a questionnaire answered by parents. DF was detected in 76 (98.7%) of the children (average of 18.4 ±1.81 permanent teeth affected). Grade TF2 was the most frequently observed (34.8%); TF5 was observed in all age groups; TF6- TF7 were observed in 12-year-olds. No association was found between DF severity and DC (Odds Ratio (OR)=1.35; 95%CI: 0.56-3.26) or MIH (OR=1.39; 95%CI: 0.43-4.46). DF severity was significantly associated with use of an indoor wood stove for food preparation (OR = 9.34; 95%CI: 1.11-78.57) and use of a pea-sized volume of toothpaste (OR = 27.42; 95%CI: 1.57-477.36). Prevalence of DC was 38.1% and prevalence of MIH was 14.4%. In this population, the frequency of DF was high and severity was associated with use of an indoor wood stove for food preparation and toothpaste amount used during childhood.

RESUMEN El objetivo de este estudio fue determinar la prevalencia y severidad de la Fluorosis Dental (FD) y la asociación de la severidad con factores de riesgo. Mediante un estudio transversal, niños (8-12 años-de-edad), nacidos en Ayapel (El Cedro-Colombia) fueron evaluados por 2 examinadores calibrados, según los criterios del índice de Thylstrup y Fejerskov (TFI) para FD. También se evaluaron la Hipomineralización molar-incisiva (HMI) y la caries dental (CD). Se aplicó un cuestionario de factores de riesgo y estilo de vida, a los padres/responsables de los niños. Se utilizó un modelo de regresión logística ordinal (p<0.05). Se encontró FD en 76 (98.7%) niños (con una media de dientes permanentes afectados de 18.4 ±1.81). La severidad categoría TF2 fue la más observada (34.8%) en los dientes evaluados. Las lesiones que presentan pérdida estructural moderada TF 6-7, fueron evidenciadas en el grupo de edad de 12 años. No se encontró asociación entre la severidad y la CD (OR=1.35; IC95%:0.56-3.26) o con HIM (OR=1.39; IC95%:0.43-4.46). Se encontró una asociación significativa con la severidad de la FD en los niños que utilizaban fogón de leña-interno para la preparación de los alimentos (OR=9.34; IC95%:1.11-78.57) y utilizaban un volumen de crema dental del tamaño de una alverja- pequeña (OR=27.42; IC95%:1.57-477.36). la prevalencia de CD fue 38.1% y de HMI fue 14.4%. La frecuencia de la FD fue alta y la severidad mostró correlación con la utilización de fogón de leña interno para la preparación de los alimentos y la cantidad de crema-dental utilizada.

Dental Fluorosis according to Birth Cohort and Fluoride Markers in an Endemic Region of Colombia.

OBJECTIVES: To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. METHODS: Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7-18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. RESULTS: In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89-1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 µg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. CONCLUSION: In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 µg F/g. It is important to monitor and explore changes in exposure in highly affected population.

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.

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.

Aesthetical perception of dental fluorosis in a Colombian low income community / Percepção estética da fluorose dentária em uma comunidade colombiana de baixa renda / Percepción estética de la fluorosis dental en una comunidad colombiana de bajos ingresos

Abstract Introduction and objective: The Dental Fluorosis (DF) is a development defect of enamel resulting from overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis (DF) in a low-income community with high DF prevalence. Materials and methods: A cross-sectional study was conducted with 171 Colombian schoolchildren aged 8 to 12 years living in low socioeconomic community (El Cedro, district of Ayapel, Córdoba, Colombia). After receiving authorization, the students were examined for DMFT and dmft indexes (WHO criteria), and for DF (TF index). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA). Data analysis was carried out using descriptive statistics, the chi-square test, the Student´s t-test, the one-way ANOVA test, and linear regression at a significance level of p ≤ 0.05. Results: The prevalence of DF in this sample was 84.8% (n=145). Only the presence of caries (DMFT/ deft≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the report of pleasant color domain. The number of teeth affected by DF had a significant positive correlation with mean overall perception of dental health. Conclusion: The presence of mild DF in children with low socioeconomic status, from a population with a high prevalence of the condition, did not seem to have an impact on the report of pleasant color of teeth domain.

Resumo Introdução e Objetivo: A fluorose dentária (FD) é um defeito de desenvolvimento do esmalte decorrente da sobre-exposição ao flúor e pode comprometer esteticamente o paciente. O presente estudo se propõe a investigar a relação entre percepção estética e fluorose dentária em uma comunidade de baixa renda com alta prevalência de FD. Materiais e métodos: Foi realizado um estudo transversal com 171 escolares colombianos de 8 a 12 anos de idade, moradores de uma comunidade de baixa renda (El Cedro, distrito de Ayapel, Córdoba, Colômbia). Após receber autorização, os estudantes foram examinados para os índices CPOD e ceod (OMS) e para o FD (TF index). As percepções estéticas foram verificadas pelo "Child Perception Questionaire about Teeth Appearence" (CQATA). A análise dos dados foi realizada por meio de estatística descritiva, teste do qui-quadrado, teste t de Student, teste ANOVA one-way e regressão linear em nível de significância de p ≤ 0,05. Resultados: A prevalência de FD nesta amostra foi de 84,8% (n = 145). Apenas a presença de cáries (CPOD/cpod≠0) teve um impacto significativo nas percepções estéticas. Uma taxa significativamente menor foi encontrada em meninas para o relato de domínio de cor agradável. O número de dentes afetados pela FD teve correlação positiva significativa com a percepção geral da saúde bucal. Conclusão: A presença de FD leve em crianças com baixo nível socioeconômico, de uma população com alta prevalência da doença, não parece ter impacto na satisfação com a coloração dos dentes.

Resumen Introducción y objetivo: La fluorosis dental (FD) es un defecto en el desarrollo del esmalte como resultado de la sobreexposición al fluoruro y puede comprometer estéticamente al paciente. Este estudio tiene como objetivo investigar la relación entre la percepción estética y la fluorosis dental en una comunidad de bajos ingresos económicos y con alta prevalencia de FD. Materiales y métodos: Se realizó un estudio transversal con 171 escolares de 8 a 12 años que viven en una comunidad socioeconómica baja (El Cedro, distrito de Ayapel, Córdoba, Colombia). Los estudiantes fueron examinados para caries dentaria (índices DMFT y dmft (criterios de la OMS) y para el fluorosis dentaria (índice TF). La percepción estética se verifico con el cuestionario sobre percepciones de los niños sobre la apariencia de los dientes (CQATA). El análisis de los datos se realizó mediante estadísticas descriptivas y las pruebas de chi cuadrado, t de Student, ANOVA de una vía y la regresión lineal (p ≤ 0.05). Resultados: La prevalencia de FD fue de 84.8% (n = 145). Solo la presencia de caries (DMFT/deft ≠ 0) tuvo un impacto significativo en las percepciones estéticas. Se encontró una tasa significativamente más baja en las niñas para el informe acerca de color agradable. La cantidad de dientes afectados por FD tuvo una correlación positiva significativa con la percepción general de la salud dental. Conclusión: La presencia de FD leve en niños con bajo nivel socioeconómico, en una población con una alta prevalencia de este defecto de esmalte, no pareció tener tuvo un impacto en la aceptción aceptar la apariencia del color de los dientes.

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.

Effect of erosive challenge before and after the restoration of primary teeth.

The aim of this in vitro study was to investigate the erosive effect of a soft drink on primary teeth before and after restoration. Enamel blocks were obtained from 64 primary canines (N = 144) and divided into 3 groups (n = 48): 1, erosive challenge before and after restoration; 2, erosive challenge after restoration; and 3, no erosive challenge (control). The blocks received standardized preparations and were restored with 1 of 4 materials (n = 12): composite resin, bulk-fill composite resin, conventional glass ionomer cement, or resin-modified glass ionomer cement. The erosive challenge consisted of immersing the blocks in a cola soft drink for 1 minute at 25°C, 4 times a day for 5 days. The microhardness, roughness, marginal infiltration, and marginal adaptation of the specimens in all 3 groups were evaluated. Data were analyzed with the Kruskal-Wallis and Bonferroni tests. The results showed that the erosive challenge significantly altered all of the evaluated properties of all of the restorative materials (P < 0.05). The erosive challenge decreased the microhardness and marginal adaptation and increased the roughness and marginal infiltration of the tested materials. Composite resin had the highest values for microhardness and marginal adaptation as well as the lowest roughness value and dye infiltration score both with and without the erosive challenge. Subjecting teeth to erosive challenge before and after restoration altered the enamel microhardness and roughness significantly more than did erosive challenge only after restoration. Composite resin was the material least affected by the erosive challenge.

Esthetic rehabilitation of anterior teeth with molar-incisor hypomineralization and dental fluorosis: a case report.

This case report describes the treatment of a patient who had molar-incisor hypomineralization associated with dental fluorosis, a diagnosis established through a comprehensive review of the clinical record, an intraoral clinical examination, and assessment of photographic records. First, dental hypersensitivity was treated with fluoride varnish, which was applied separately to each dental quadrant. Subsequently, the functional and esthetic reconstruction of the permanent maxillary central incisors was completed in a single session through the placement of direct composite resin veneers. After the treatment, the patient was reexamined monthly for 12 months to evaluate the durability of the restorations. At the 12-month follow-up, no fractures or pigmentations were observed, and only a slight loss of brightness of the restorations was noted. The dental hypersensitivity had been eliminated. When an adhesive restorative technique with composite resin is well executed, it is possible to obtain satisfactory and long-lasting esthetics and relief of painful symptoms.

Esthetic reconstruction of teeth with enamel hypoplasia.

Hypoplasia is an enamel developmental defect characterized by a quantitative disturbance in the formation of mineralized tissue. Among its etiologic factors are local and systemic causes, trauma and dental infections being the most common. This case report presents the functional and esthetic rehabilitation of a 12-year-old boy diagnosed with hypoplasia in the maxillary central incisors. His chief complaints were the unesthetic appearance and sensitivity of the affected teeth. The teeth were restored with composite resin placed with the aid of a direct silicone palatal guide, and the patient was followed up for 12 months. The treatment plan allowed the restoration and improvement of function and esthetics, resulting in patient satisfaction.

The effect of amoxicillin on dental enamel development in vivo

Abstract 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.

Frequência de acidentes cirúrgicos transoperatórios em exodontias realizadas em um curso de graduação / Frequency of transoperative surgical accidents in extractions performed in a graduation course

As exodontias são os procedimentos cirúrgicos mais realizados nas graduações de Odontologia. Embora sejam preconizadas técnicas seguras e simples, esse tipo de procedimento não deixa de ser invasivo, sendo passível de acidentes e complicações que dificultam o sucesso do tratamento e até mesmo colocam a saúde do paciente em risco. Essa pesquisa propõe avaliar a frequência de acidentes cirúrgicos transoperatórios em 232 exodontias realizadas no curso de graduação em Odontologia da Faculdade de Ciências Biomédicas de Cacoal, entre julho e outubro de 2015, assim como relacioná los com as características individuais dos elementos extraídos e com a complexidade do caso. Em 71 exodontias realizadas houve a incidência de acidentes transoperatórios. Ocorreram 23 fraturas de coroa, 21 fraturas de raiz, 19 lacerações do tecido gengival, 7 fraturas do osso alveolar, 2 escoriações em pele na comissura labial e 1 luxação do dente vizinho. Esses acidentes prevaleceram principalmente em elementos com raízes longas, finas ou curvas ou com destruição coronária. A maioria dos acidentes já estava prevista pelos operadores, sendo estas facilmente controladas no ato cirúrgico, sem gerar maiores complicações aos pacientes. Concluiu-se que um bom planejamento cirúrgico é fundamental na prevenção e/ou controle dos acidentes transoperatórios... (AU)

The extractions are the most performed procedures in Dentistry graduation course. Although safe and simple techniques are recommended, this procedure does not cease to be invasive and may be subject to accidents and complications that hinder the success of treatment and even put the patient's health at risk. This survey aimed to evaluate the frequency of transoperative surgical accidents in 232 extractions performed in the Dentistry graduation course at the Faculty of Biomedical Sciences of Cacoal, between July and October of 2015, and relate them to the characteristics of the extracted element and the complexity of the case. 71 extractions had transoperative acidentes. There were 23 crown fractures, 21 root fractures, 19 lacerations of the gum tissue, 7 fractures of the alveolar bone, 2 excoriation on the skin in labial commissure and one dislocation of the next tooth. These accidents predominate mainly in elements with long, thin or curved roots or with coronary destruction. Most of the accidents were already predicted by the operators, being these easily controlled in the surgical act, without generating greater complications to the patients. It was also concluded that a good surgical planning is essential in the prevention and / or control of transoperative accidents... (AU)

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.

Aesthetic rehabilitation with strip crowns in Pediatric Dentistry: a case report / Reabilitação estética com coroas de acetato em Odontopediatria: relato de caso

Abstract Even with all the preventive measures used in pediatric dentistry, early childhood caries is a problem faced daily in pediatric dentistry, and mainly affects the vestibular surface of the anterior teeth in children younger than 71 months. The present study reports a case of aesthetic-functional rehabilitation per formed with the help of laboratory-made strip crows and composite in a 5-year-old patient affected by multiple lesions of early childhood caries. Composite resin restorations were performed on all upper anterior teeth to restore aesthetics and function, offering a better quality of life for the child and her family. The preparation of composite resin crowns with the help of strip crowns resulted in a shorter clinical time, a better aesthetic result and the restoration of the patient's smile and self-esteem.

Resumen A pesar de todas las medidas preventivas utilizadas en odontología pediá trica, caries de la primera infancia es un problema que enfrentan todos los días en la odontología pediátrica, y sobre todo afecta a la cara vestibular de los dientes anteriores en niños menores de 71 meses. El presente es tudio reporta un caso de rehabilitación estético-funcional realizado con la ayuda de coronas de acetato hechas en laboratorio y resina compuesta en un paciente de 5 años de edad afectado por múltiples lesiones de caries en la primera infancia. Se realizaron restauraciones de resina compuesta en todos los dientes anteriores superiores para restaurar la estética y la función, ofreciendo una mejor calidad de vida para el niño y su familia. La preparación de coronas de resina compuesta con la ayuda de coronas de tiras dio como resultado un tiempo clínico más corto, un mejor resultado estético y la restauración de la sonrisa y la autoestima del paciente.

Resumo Mesmo com todas as medidas preventivas utilizadas em odontopediatria, a cárie pre coce da infância, consiste um problema enfrentado diariamente pelo Odontopediatra, e acomete principalmente a superfície vestibular de dentes anteriores em crianças menores de 71 meses. Este estudo relata um caso de reabilitação estética-funcional em uma paciente de 5 anos de idade. Foram realizadas restaurações de resina com posta em todos os dentes superiores anteriores para restabelecimento da estética e função, oferecendo melhor qualidade de vida a criança e seu núcleo familiar. Com a confecção de coroas de resina composta conseguiu-se menor tempo clínico, bom re sultado estético e o restabelecimento do sorriso e auto-estima da paciente.

Diagnóstico y tratamiento conservador de quiste dentígero: seguimiento a 3 años / Diagnóstico e tratamento conservador em cisto dentígero: acompanhamento de 3 anos / Diagnosis and conservative treatment of dentigerous cyst: 3-year follow-up

Resumen El quiste dentígero es el quiste de desarrollo odontogénico más común. Aunque puede afectar cualquier diente incluido, los molares y caninos son los más afectados, seguidos por los premolares e incisivos. Este trabajo tiene como objetivo relatar el caso de una paciente de 11 años de edad quien refería ausencia del segundo premolar inferior derecho (45) en el arco dental. De esa manera, se hizo una revisión de literatura abordando el diagnóstico y tratamiento de esta condición. Luego del el exámen clínico y radiográfico se pudo observar una imagen compatible con un de quiste dentígero, cuyo diagnóstico fue confirmado por el examen histopatológico y tomografía computarizada de haz cónico (cone beam). Fue realizado un procedimiento quirúrgico conservador de descompresión utilizando el resultado de la tomografía como guía quirúrgica. Después de 4 meses de seguimiento clínico y radiográfico, se realizó la enucleación de la lesión por curetaje. Se hizo seguimiento de la paciente durante 3 años hasta la erupción completa del diente 45 y su alineación en el arco. No se observaron lesiones y el tratamiento ortodóntico fue eficaz. La técnica de descompresión quirúrgica fue segura, evitó daños de otras estructuras importantes y proporcionó una rápida recuperación de la paciente.

Resumo O cisto dentígero é o cisto de desenvolvimento odontogênico mais comum. Pode envolver qualquer dente incluso, embora molares e caninos sejam os mais afetados, seguidos pelos pré-molares e incisivos. Este trabalho tem como objetivo relatar o caso de uma paciente de 11 anos de idade com queixa de ausência do segundo pré-molar inferior direito (45) no arco dentário. Assim, uma revisão da literatura abordando o diagnóstico e tratamento desta condição é apresentada. No exame clínico e radiográfico pode-se notar imagem sugestiva de cisto dentígero, entretanto o diagnóstico foi confirmado por exame histopatológico e tomografia computadorizada de feixe cônico (cone beam). Optou-se por procedimento cirúrgico conservador de descompressão utilizando o exame cone beam como guia cirúrgico. Depois de 4 meses de acompanhamento clínico e radiográfico foi realizada a enucleação da lesão por curetagem. A paciente foi acompanhada durante 3 anos até a erupção completa do dente 45 e seu alinhamento no arco. Nenhuma lesão foi registrada e o tratamento ortodôntico mostrou-se eficaz. A técnica de descompressão cirúrgica foi segura, evitou danos a estruturas nobres e proporcionou uma rápida recuperação da paciente.

Abstract Dentigerous cyst is the most common developmental odontogenic cyst. It can involve any included tooth, although molars and canines are most frequently affected, followed by premolars and incisors. The aim of this article was to report the case of an 11-year-old female patient complaining of an eruption delay of a mandibular second premolar (45). Therefore, a literature review regarding the diagnosis and treatment of this condition is presented. At clinical and radiographic examination, the image suggested a dentigerous cyst; however, the diagnosis was confirmed by histopathological and cone-beam computed tomography (CBCT) exams. Surgical planning was carried out using a conservative method involving surgical decompression. CBCT was used as a surgical guide. At 4-month clinical and radiographic follow-up, cystic enucleation was performed by curettage. The patient was followed for 3 years until complete eruption and alignment of the teeth occurred. No lesion was recorded, and orthodontic treatment was proven to be successful. The surgical decompression was completely safe, avoiding damage in important structures, and resulted in rapid recovery of the patient.

Qualidade de vida e percepção estética da cárie dentária / Quality of life and aesthetic perception of dental caries / Calidad de vida y la percepción estética de la caries dental

Objetivo: Relacionar a percepção estética e a qualidade de vida relacionada à saúde bucal na presença de cárie dentária em escolares. Métodos: Estudo transversal realizado em Araraquara, São Paulo, Brasil, entre outubro de 2014 e março de 2015, com 260 escolares, de 8 a 10 anos, divididos em grupos clínicos segundo a presença de cárie dentária. Utilizaram-se questionários "Child Perceptions Questionnaire" e "Child Questionnaire About Teeth Appearence" e avaliação clínica para detecção de dentes cariados, perdidos ou obturados em dentes permanentes e decíduos. Dados analisados através do teste qui-quadrado e Mann Whitney, p ≤ 0.05. Resultados: Dos 260 escolares, 130 (50%) apresentavam a doença cárie, com maior frequência (62,0%) na faixa etária 8 anos. Variáveis socioeconômicas, como menor renda familiar e menor escolaridade da mãe, estiveram associadas ao grupo com cárie (p<0,05 e p<0,01 respectivamente). No grupo com cárie, os domínios sintomas orais (4,9 vs 6,6), bem-estar emocional (3,0 vs 4,7) e bem-estar social (2,2 vs 3,5) foram maiores que no grupo sem cárie. Com relação à percepção estética, o domínio psicológico (0,94 vs 1,27) e a percepção geral de saúde bucal (2,26 vs 2,93) se apresentaram maiores no grupo com cárie. Na regressão linear, observou-se contribuição significativa dos números de dentes permanentes cariados e o índice ceo-d (dentes decíduos cariados, extraídos e obturados) na pior percepção de qualidade de vida. Conclusão: A cárie dentária afeta negativamente a percepção estética e a qualidade de vida em crianças de 8 a 10 anos.

Objetive: To relate the aesthetic perception and the oral health-related quality of life in the presence of dental caries in schoolchildren. Methods: Cross-sectional study carried out in Araraquara, São Paulo, Brazil, from October 2014 to March 2015, with 260 schoolchildren aged 8 to 10 years, divided into clinical groups according to the presence of dental caries. The Child Perceptions Questionnaire and the Child Questionnaire About Teeth Appearance were applied and a clinical evaluation of permanent and deciduous dentition was conducted for detection of decayed, missing or filled teeth. Data was analyzed using the chi-square test and Mann-Whitney's test, p ≤ 0.05. Results: Of the 260 students, 130 (50%) had caries disease, with the highest frequency (62.0%) in 8-year-olds. Socioeconomic variables, such as lower family income and lower maternal schooling, were associated with the dental caries group (p<0.05 and p<0.01, respectively). In the dental caries group, the domains oral symptoms (4.9 vs 6.6), emotional well-being (3.0 vs 4.7) and social well-being (2.2 vs 3.5) were higher than in the caries-free group. Regarding the aesthetic perception, the psychological domain (0.94 vs 1.27) and the overall perception of oral health (2.26 vs 2.93) were higher in the group with dental caries. In the linear regression, there was a significant contribution of the number of permanent decayed teeth and the dmft (decayed, missing and filled deciduous teeth) index to the worst perception of quality of life. Conclusion: Dental caries negatively affects aesthetic perception and quality of life in 8- to 10-year-old children.

Objetivo: Relacionar la percepción estética y la calidad de vida relacionada con la salud bucal de escolares con caries dental. Métodos: Estudio transversal realizado en Araraquara, São Paulo, Brasil, entre octubre de 2014 y marzo de 2015 con 260 escolares entre 8 y 10 años que fueron divididos en grupos clínicos según la presencia de caries dental. Se utilizaron los cuestionarios "Child Perceptions Questionnaire" y "Child Questionnaire About Teeth Appearence" y la evaluación clínica para detectar los dientes con caries, los perdidos u con obturaciones en dientes permanentes y deciduos. Los datos fueron analizados a través de las pruebas Chi-cuadrado y Mann Whitney con p ≤ 0,05. Resultados: Entre los 260 escolares, 130 (50%) tenían caries con más frecuencia en la franja de edad de 8 años (62,0%). Las variables socioeconómicas como la menor renta familiar y menor escolaridad de la madre se asociaron con el grupo que tenía caries (p<0,05 y p<0,01 respectivamente). Los dominios síntomas orales (4,9 vs 6,6), el bien estar emocional (3,0 vs 4,7) y el bien estar social (2,2 vs 3,5) fueron mayores en el grupo con caries que el grupo sin caries. Respecto la percepción estética, el dominio psicológico (0,94 vs 1,27) y la percepción general de salud bucal (2,26 vs 2,93) se presentaron mayores en el grupo con caries. A partir de la regresión linear se observó la contribución significativa de los números de dientes permanentes con caries y el índice ceo-d (dientes deciduos con caries, extraídos y con obturación) para la peor percepción de calidad de vida. Conclusión: La caries dental afecta de manera negativa la percepción de la estética y la calidad de vida de niños entre 8 y 10 años.

Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm.