Influence of genetics on the occurrence of enamel hypomineralization affecting permanent and primary teeth: A scoping review.

BACKGROUND: Molar incisor hypomineralization (MIH) is prevalent worldwide and is a challenge for clinicians who provide oral care to children. Molar incisor hypomineralization has been considered a multifactorial disturbance that results from a combination of environmental and genetic factors. AIM: This scoping review followed the Joanna Briggs Institute protocol and aimed to identify the available evidence of the genetic influence on the etiology of MIH. DESIGN: The search strategy was conducted in multiple databases, including PubMed, BVS, Embase, Web of Science, and Scopus. Two trained reviewers, requiring a third reviewer in case of disagreements, collected evidence. RESULTS: Of 563 retrieved studies, 17 were included in the review. From 14 studies performed in humans, 10 investigated DNA polymorphisms, one analyzed DNA methylation, one aimed model of inheritance, and two focused on the phenotype in twins or in the family. Three animal studies were based on the null expression of genes. CONCLUSION: This scoping review, based on the studies that used different methodologies, reinforces the hypothesis of a genetic contribution to the multifactorial etiology of MIH. The available data are limited in terms of size and origin of the samples. Hence, further genetic studies are still required.

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.

Symmetry of carious lesions in primary and permanent teeth in children as a predictor of future caries patterns.

This study evaluated the bilateral symmetry of carious lesions in the primary and permanent teeth of children. The clinical records of patients aged 3 to 14 years who had carious lesions were evaluated. Dental caries was assessed using the modified decayed, missing, and filled teeth (dmft/DMFT) index, and the biofilm was assessed using the O'Leary plaque control record. The results were analyzed considering the presence or absence of caries and the stages of caries. The kappa coefficient between the left and right sides was calculated, and the chi-square test was applied (P < 0.05). The sample consisted of 206 children and 4802 teeth (2127 primary and 2675 permanent teeth). Fifty-one percent of the sample was female, and the mean age was 8.28 (SD 1.62) years. The mean number of dmft/DMFT was 4.45 (SD 3.61), and the mean O'Leary plaque index was 27.38%. The overall symmetry for the presence/absence of dental caries was 49.5% (n = 342), and the symmetry for the stage of caries was 43.5% (n = 301). The symmetry was similar in primary and permanent teeth for the presence/absence of caries (50.83% and 47.39%, respectively) and stages of caries (42.08% and 45.89%, respectively). Among the teeth that showed symmetry of carious lesions, there was an association between the hygiene condition and the presence of lesions in all maxillary and mandibular primary second molars and in the mandibular permanent right first molar (P < 0.05). A bilateral symmetric relationship of carious lesions was observed in the primary canines, primary first and second molars, permanent central and lateral incisors, first premolars, and permanent first molars in both the maxillary and mandibular arches. The results suggest that the presence of a carious lesion on a tooth surface can predict vulnerability to caries on the contralateral tooth, allowing the dentist to pursue targeted preventive action.

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.

Caries lesion transition patterns of schoolchildren in a fluoridated community in Brazil.

OBJECTIVE: To describe the caries lesion transition pattern in permanent tooth surfaces over 2 years among a convenience sample of children in a fluoridated (0.8 ppm F) low-socioeconomic community of Brazil. MATERIAL AND METHODS: One hundred forty-nine schoolchildren (7-12 years) were examined for caries using Nyvad criteria at baseline and after 2 years. Descriptive analysis was used to evaluate caries lesion transition patterns. RESULTS: Less than 1% of sound surfaces and non-cavitated caries lesions at baseline progressed to cavitation stage within 2 years. 12.7% of the active non-cavitated (ANC) lesions became inactive, 34.7% regressed to sound, 48.0% remained active, and 4.6% progressed to cavitated/filled stages at follow-up. Similarly, 55.2% of the inactive non-cavitated (INC) lesions at baseline remained inactive, 33.3% regressed to sound, 8.0% progressed to cavitated/filled lesions, while only 3.5% progressed to ANC lesions. CONCLUSION: The caries lesion transition pattern in this child population exposed to water fluoride and fluoride toothpaste showed that a low proportion of sound surfaces and non-cavitated lesions progressed to cavitation within the 2-year follow-up. Caries arrest was mainly ascribed to a high proportion of active non-cavitated lesions regressing to sound or inactive lesions. CLINICAL RELEVANCE: Caries activity can be controlled by regular exposure to fluoridated water and fluoridated toothpaste.

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.

Management of dental caries lesions in Latin American and Caribbean countries.

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

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.

Management of dental caries lesions in Latin American and Caribbean countries

Abstract Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

The effect of pulp inflammation and premature extraction of primary molars on the successor permanent teeth. A retrospective study.

BACKGROUND: Untreated caries on primary molars often leads to pulp inflammation and extraction. AIM: To retrospectively investigate the effect of pulp inflammation and extraction of primary molars on their successors regarding alignment in the dental arch and developmental enamel defects (DED). DESIGN: The participants in this study were children at public schools in Petropolis (Brazil), who participated in a 3-year longitudinal clinical trial. Children (N = 44) were selected for the present study if they had at least one erupted premolar of which the predecessor primary molar presented pulp inflammation at baseline or during any of the 6-month follow-up assessments. All premolars were examined for DED and misalignment. Distinction was made between extraction performed before (E <8) or after the age of 8 years (E ≥8). Distinction was also made between pulp inflammation occurred before (P < 7) or after the age of 7 years (P ≥ 7). A logistic regression analysis was performed, and the odds ratio was calculated. RESULTS AND CONCLUSIONS: Misalignment occurred more frequently in E <8 as compared to E ≥8 (OR = 2.85; P = .03). There was no significant difference in DED between P < 7 and P ≥ 7. CONCLUSION: Misalignment of premolars occurs more frequently when the predecessor primary molars are extracted before the age of 8 years.

Reliability and validity of a new classification of MIH based on severity.

OBJECTIVES: To describe a new molar-incisor hypomineralization (MIH) severity scoring system (MIH-SSS) that focuses on the defects' severity and to assess the system's validity and reliability over 3 years. MATERIALS AND METHODS: One hundred eighty-one children diagnosed with MIH were examined by MIH-SSS. For reliability assessment, 15-20 children were examined twice, and analyses were performed at the tooth level at four different cutoff points. Follow-up examinations were performed over 36 months. Only teeth presenting MIH opacities at baseline were assessed. Odds ratios were calculated to evaluate the chance of post-eruptive breakdown (PEB) occurrence related to the colors of MIH defects. Survival curves were created for different types of teeth (molars and incisors) based on white and yellow opacities. The Kaplan-Meier method was used with PEB as the outcome. RESULTS: According to the MIH-SSS, kappa values ranged from 0.82 to 0.88. Regarding the longitudinal evaluation, for molars and incisors, yellow/brown opacities had a significantly higher chance to evolve to dentin breakdown compared with white/creamy opacities (OR = 2.54, OR = 10.58, respectively). Survival analysis showed that the occurrence of PEB was more frequent in the first evaluation period (12 months). CONCLUSION: MIH-SSS, which provides detailed information about MIH severity, is a valid instrument presenting high reliability. Yellow/brown opacities progressed more than did white/creamy opacities. CLINICAL RELEVANCE: It is of paramount importance to detect any surface breakdown as early as possible to be able to avoid pain and caries progression. Moreover, this is the first paper that shows survival curves for MIH enamel breakdown over time.

Breakdown of demarcated opacities related to molar-incisor hypomineralization: a longitudinal study.

OBJECTIVES: This prospective longitudinal study aimed to evaluate if the occurrence of post-eruptive breakdown of demarcated opacities in hypomineralized teeth is influenced by the color or location of the opacity. MATERIALS AND METHODS: Patients diagnosed with molar-incisor hypomineralization (MIH) between 2012 and 2014 were eligible. Two calibrated examiners performed the initial and follow-up evaluations according to European Academy of Paediatric Dentistry (EAPD) criteria. Sixty-five patients were included. Fifty-eight (89.2%), with a mean age of 8.8 years (SD: 1.4), were reassessed after 1 year. Two hundred and nine of 1155 tooth surfaces were considered for the study: 86 with white opacity (OP-W), 91 with yellow opacity (OP-Y), and 32 with enamel breakdown (EB). RESULTS: From the OP-W, OP-Y, and EB, 14, 27.5, and 46.9% worsened to breakdown exposing dentin, atypical restoration, or extraction (DB + RA or EXT), respectively. Yellow opacities tended to be more prone to breakdown than white opacities. The occurrence of EB, DB + AR, or EXT was not influenced by the location (p = 0.25). CONCLUSIONS: The color of the opacity seems to play an important role on the occurrence of fracture and should be considered as a potential predictor. CLINICAL RELEVANCE: Dentists should be aware that demarcated opacities related to MIH tend to fracture over time. Moreover, children with MIH should be seen at shorter intervals.

Efficacy of sealing occlusal caries with a flowable composite in primary molars: A 2-year randomized controlled clinical trial.

OBJECTIVES: This randomized controlled clinical trial evaluated the efficacy of sealing carious dentin in controlling the progression of lesions in primary molars for 2-year follow-up. MATERIALS AND METHODS: Children (6.79 ±â€¯1.81 years, n = 28) presenting primary molars with occlusal caries in the outer half of dentine were randomized and allocated into 2 groups: test (sealing caries with a flowable resin - SC) and control (partial removal of caries followed by restoration - PRC). The primary outcomes were: the clinical success of restorations evaluated by USPHS criteria and the radiographic analysis of caries progression. The children anxiety was evaluated by a Facial Image Scale; and the time required to perform the treatments was registered. RESULTS: In 21 patients evaluated after 2 years, 48 primary molars were analyzed. Clinically, there was no difference between the groups. There was no difference between treatments (p = 0.848) considering lesion progression. The anxiety level did not change after the two interventions (p = 0.650). The treatment time of SC (9.03 ±â€¯1.91 min) was lower (p = 0.002) than the PRC time (17.13 ±â€¯5.26 min). CONCLUSION: Sealing carious dentin may be used in dentistry since it did not alter the children anxiety, reduced the chair time and demonstrated clinical success rate and no radiographic difference in relation to the partial caries removal followed by restoration.

Influence of the microbiological component of Cariogram® for evaluating the risk of caries in children.

OBJECTIVE: To compare the risk for caries in children as determined by Cariogram® software (CS; Stockholm, Sweden) with and without its microbiological component and by a form based on Cariogram® (FBC). METHODS: Children (n = 28) aged 3-9 years were included. Data were collected clinically and from anamnesis. The salivary levels of Streptococcus mutans (SM) were evaluated. A linear regression model was used to determine which variables were predictive for each type of risk analysis. Caries risk was the dependent variable and the independent variables were caries experience, related disease, plaque amount, diet frequency, salivary levels of SM, fluoride sources and clinical judgment. A paired Student t-test was used for the following comparisons: (a) CS with and without SM; (b) CS without SM and FBC; (c) CS with SM and FBC. RESULTS: The mean dmft/DMFT was 5.56 ± 2.51. There was no difference between the methods (p < .05). Regardless of caries risk, the children presented the same levels of SM (p = .889). Caries experience, plaque amount, diet frequency and fluoride sources were predictors of caries risk in all assessment methods. Clinical judgment was a significant predictor in CS. CONCLUSIONS: Caries experience, plaque amount, diet frequency and fluoride sources are valuable predictors of caries risk; microbiological tests are not necessary for evaluating caries risk in children, which can be assessed similarly by CS without SM and FBC.

A systematic review on the association between molar incisor hypomineralization and dental caries.

BACKGROUND: Molar incisor hypomineralization (MIH) is a defect of enamel. The lower strength of the enamel can lead to fractures that predispose for plaque accumulation and caries. AIM: This systematic review aimed to assess the association between MIH and caries. DESIGN: Studies involving children of all ages, which reported results on MIH and caries in the permanent dentition, were considered eligible. A search was performed in PubMed and was limited to the period from January 2003 to November 2015, and to studies written in English. Reviews, meta-analyses, and case reports were excluded. The studies were evaluated by use of the Newcastle-Ottawa Quality Assessment Scale (NOS). RESULTS: Seventeen publications were compiled in the review. Most publications reported that children with MIH have higher caries experience. One study did not observe a difference in DMF values among children affected or not by MIH. Three studies reported that children with MIH were 2.1 to 4.6 times more likely to have caries in the permanent dentition than children without MIH. CONCLUSIONS: A significant association between MIH and caries was found. The results should, however, be interpreted cautiously due to the lack of high-quality studies. The present systematic review confirms the need for further well-designed studies.

Relating Molar Incisor Hypomineralization and Caries Experience Using the Decayed, Missing, or Filled Index.

PURPOSE: This case-control study aimed to investigate the association between molar incisor hypomineralization (MIH) and caries experience in seven- to 11-year-old children. METHODS: Children seen in a pediatric dental clinic in 2011 to 2012 and born in 2002, 2003, or 2004 were considered eligible. Children with decayed, missing, or filled teeth in the permanent dentition (DMF-T) were allocated to the case group, and those with no DMF-T were allocated to the control group. An examiner assessed MIH according to European Academy of Pediatric Dentistry criteria and caries according to World Health Organization criteria. The odds ratio was calculated to evaluate the association between MIH and caries; the chi-square test was used to analyze the association between categorical variables, and the Mann-Whitney test was used to compare means. RESULTS: The final sample comprised 57 children in the case group and 98 in the control group. The groups were similar in relation to age, gender, and caries experience in the primary dentition. MIH children were 5.89 (95 percent confidence interval equals 2.69 to 12.86; P<0.05) times more likely to have a DMF-T greater than zero. CONCLUSIONS: Children with decayed, missing, or filled permanent teeth are more likely to have MIH.

Efficacy of chemomechanical caries removal in reducing cariogenic microbiota: a randomized clinical trial.

The aim of this study was to compare the efficacy of chemochemical methods (Carisolv™ and Papacárie®) versus the manual method (excavators) in reducing the cariogenic microbiota in dentine caries of primary teeth. Forty-six healthy children (5 to 9 years old) having at least one primary tooth with a cavitated dentine carious lesion were included in the study. The teeth presented no clinical or radiographic signs of pulpal involvement. The sample of 74 teeth was randomly divided into three different groups: Papacárie® (n = 25), Carisolv™ (n = 27) and Manual (n = 22). Samples of carious and sound dentine were collected with sterile excavators before and after caries removal in the three groups. The dentine samples were transferred to glass tubes containing a 1mL thioglycollate medium used as a carrier and enriched for microbiological detection of mutans streptococci and Lactobacillus spp, after incubation for 6h at room temperature. The minimum detection value for colony forming units (CFU) was 3.3 x 102 CFU/ml, and the results were converted into scores from 0 to 4. A significant difference was observed in relation to the microbiological scores before and after caries removal for all methods (Wilcoxon test; p < 0.001). The use of chemomechanical methods for caries removal did not improve the reduction of cariogenic microorganisms in dentine caries lesions, in comparison with manual excavation.

Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth. DATA: Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software. SOURCES: A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013. STUDY SELECTION: From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered "high" risk of bias, and four "low" risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I(2)=29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p=0.002) compared with Placebo. CONCLUSION: Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence. CLINICAL SIGNIFICANCE: Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth.