Knowledge of Dentists about Hypomineralization Enamel Defects: A Cross-Sectional Study

ABSTRACT Objective: To evaluate a group of Brazilian dentists on their knowledge of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molars (HSPM) related to clinical aspects, consequences, and diagnostic criteria. Material and Methods: In this cross-sectional, the participants were invited by e-mail and Whatsapp® to answer a questionnaire about their knowledge of hypomineralization enamel defects (MIH/HSPM) on the Google Forms® platform. The questionnaire comprised eight questions about personal data and multiple-choice questions about their knowledge concerning clinical aspects, diagnostic criteria of MIH/HSPM and differential diagnosis through clinical images. Chi-square test was applied with the significance level set at 5%. Results: Most participants (n = 492; 91.1%) reported having knowledge about MIH/HSPM. The general dentists gave more incorrect answers (n = 40; 65.6 %;) about dental tissues affected by MIH/HSPM. Overall, 83.3% of the dentists gave the correct answer to which dentitions are associated with this condition. In addition, most dentists presented knowledge about the consequences related to possible fractures (n= 487; 90.2%) and about an increased risk of caries (n= 479; 88.9%) in the affected teeth. Regarding the differential diagnosis performed through clinical images, most participants gave incorrect answers (p≤0.001). Conclusion: The participants presented knowledge about the dentition associated with this condition and possible consequences related to the teeth affected by MIH/HSPM; however, they showed difficulties concerning clinical diagnostic criteria.

Percepção estética e desconforto de pacientes brasileiros em tratamento com bráquetes vestibulares metálicos e cerâmicos, linguais e alinhadores Invisaling® / Esthetic perception and discomfort of Brazilian patients undergoing treatment with metallic and ceramic vestibular brackets, lingual brackets and Invisaling® aligners

Resumo O tratamento ortodôntico experimenta evolução contínua em seus aparelhos, principalmente por questões estéticas e de conforto. Objetivo: avaliar a satisfação e desconforto relatados por pacientes submetidos ao tratamento ortodôntico com bráquetes vestibulares metálicos e cerâmicos, bráquetes linguais e alinhadores Invisalign®. Material e métodos: Aplicação de um questionário padronizado a 126 pacientes de ambos os sexos, em tratamento ortodôntico em consultórios particulares há pelo menos 90 dias, sem outro acessório ortodôntico. Os pacientes foram divididos em 4 grupos: grupo I (n=30) bráquetes vestibulares metálicos, grupo II (n=30) bráquetes estéticos vestibulares, grupo III (n=32) alinhadores Invisalign® e grupo IV (n=34) bráquetes fixos linguais. A comparação entre os grupos foi feita pelo teste do qui-quadrado e, quando este indicou diferença estatisticamente significativa, foram realizadas comparações múltiplas pelo teste de proporções. Resultados: Os bráquetes metálicos vestibulares foram mais percebidos pelos demais e trouxeram maior desconforto estético. Os bráquetes cerâmicos foram menos percebidos pelos demais do que os bráquetes vestibulares metálicos. Os alinhadores foram menos percebidos pelos outros do que os bráquetes vestibulares, causaram menos dificuldades na fala e na escovação, menos desconforto nas bochechas e menos dificuldades na fala. Os bráquetes linguais trouxeram menos desconforto estético, revelando também maior desconforto na língua e menos desconforto na bochecha. Conclusão: Os pacientes relataram maior desconforto estético com bráquetes vestibulares metálicos. Aparelhos linguais e alinhadores foram menos percebidos pelos demais e trouxeram menos desconforto estético aos pacientes. Todos os pacientes tratados com alinhadores o usariam novamente caso precisassem de um novo tratamento.(AU)

Abstract Orthodontic treatment experiences continuous evolution in its appliances, especially due to esthetic and comfort reasons. Objective: The aim of this study was to evaluate the satisfaction and discomfort reported by patients undergoing orthodontic treatment with metallic and ceramic vestibular brackets, lingual brackets and Invisalign® aligners. Material and methods: Application of a standardized questionnaire to 126 patients of both genders, undergoing orthodontic treatment in private orthodontic offices for at least 90 days, with no other orthodontic accessory. Patients were divided into 4 groups: group I (n=30) vestibular metallic brackets, group II (n=30) vestibular esthetic brackets, group III (n=32) Invisalign® aligners and group IV (n=34) lingual fixed brackets. Comparison between the appliances were made by the chi-square test, and when this indicated a statistically significant difference multiple comparisons were performed by the test of proportions. Results: Vestibular metallic brackets were more perceived by others and brought greater esthetic discomfort. Ceramic brackets were less perceived by others than metallic vestibular brackets. Aligners were less perceived by others than vestibular brackets, caused fewer speech and brushing difficulties, less discomfort on the cheeks and less speech difficulties. Lingual brackets brought less esthetic discomfort, revealing also more tongue discomfort and less cheek discomfort. Conclusion: Patients reported more aesthetic discomfort with metallic vestibular brackets. Lingual appliances and aligners were less perceived by others and brought less esthetic discomfort to patients. All aligners patients would use these appliances again if they needed new treatment.(AU)

Defining the Prevalence of Molar Incisor Hypomineralization in Brazil

Abstract Objective: To define the prevalence of Molar Incisor Hypomineralization (MIH) in Brazil since the reports ranged from 2.5% to 40.2%. Material and Methods: We studied 407 children from 7 to 14 years of age. MIH was measured using the European Academy of Paediatric Dentistry criteria of 2003. Clinical data were collected by a calibrated dentist (Kappa=0.88) and included affected teeth and degree of MIH severity (mild/severe). Mild MIH cases were considered when the tooth presented demarcated opacity ≥ 1.0mm, without any loss of structure. While severe cases were defined by teeth in which loss of structure was present, or past or current lesion that required treatment, or presence of atypical restorations. In addition, published data (nine studies) reporting MIH in Brazilians were identified, and the heterogeneity of these studies was tested (I2 index/ p≤0.01). Results: In the original sample studied, the majority of patients were males (55.3%; n = 225), with an average age of 10.1 years (± 2.1 years). The prevalence of MIH in this group was 14.5% (59 affected in 407), and most of the affected teeth had a mild degree of alteration (77.4% or 202 in 261 teeth). Conclusion: A meta-analysis including nine published reports, and our original data showed that MIH prevalence in Brazil is 13.48 (95% CI, 8.66% -18.31%).

Padrões de manifestação dos defeitos de Hipomineralização Molar Incisivo e influência na experiência e atividade de cárie dentária / Affection patterns of Molar Incisor Hypomineralization Defects and their influence on dental caries experience and activity

Os objetivos do presente estudo foram: 1) avaliar os padrões de manifestação dos defeitos de Hipomineralização Molar Incisivo entre arcos e hemiarcos dentários, em relação à simetria de acometimento, fenótipos e o envolvimento de outros grupos de dentes; 2) relacionar a cor e localização das superfícies afetadas com a presença de fraturas pós eruptivas (FPE), lesão de cárie e restaurações; 3) verificar a influência das FPE e opacidades sobre os índices de dentes cariados, perdidos e obturados (ceod/CPO-D) e International Caries Detection and Assessment System (ICDAS), respectivamente. Trata-se de um estudo do tipo observacional transversal, realizado nas clínicas de Odontopediatria da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro. Foram realizados dois estudos (estudo 1: n=35; estudo 2: n=39), com uma amostra de conveniência formada por crianças e adolescentes com idade entre 3 a 14 anos, que possuiam pelo menos um primeiro molar permanente (PMP) ou segundo molar decíduo (SMD) com sinais de hipomineralização, de acordo com o critério da European Academy of Paediatric Dentistry. Para o estudo 1 os testes Qui quadrado, exato de Fisher, t de Student e correlação de Pearson foram utilizados para verificar a possibilidade das associações entre simetria, cor, localização e situação clínica (p≤0,01). No estudo 2, para verificar a influência das FPE e opacidades sobre os índices ceo-d/CPO-D e ICDAS foi utilizado o teste Qui quadrado. Não houve simetria entre o número de opacidades, cor e gravidade (fenótipos). O número médio de dentes afetados nos pacientes que apresentaram PMPs ou SMDs com defeitos graves (5,63 ± 2,83) foi maior (p<0,01) do que nos pacientes que apresentaram PMPs ou SMDs com defeitos leves (2,62 ± 0,92). O número de superfícies afetadas em PMPs ou SMDs foi associado ao acometimento de caninos. Opacidades marrom-amareladas em dentes posteriores foram relacionadas a presença de FPE (p <0,01). A presença de hipomineralização em região de esforço mastigatório foi associada com cárie, restaurações ou FPE (p = 0,0014). Ceo-d/CPO-D e ICDAS tendem a sobreestimar a relação entre hipomineralização e cárie dentária devido às características semelhantes entre as duas condições (exposição de dentina por FPE e opacidades). Conclui-se que a presença de hipomineralização ocorreu de forma simétrica entre arcos e hemiarcos, embora não associada aos mesmos fenótipos. O número de superfícies afetadas nos PMPs ou SMDs foi associado à presença de sinais de hipomineralização em caninos. Opacidades em superfícies localizadas em regiões de esforço mastigatório mostrou correlação positiva com presença de lesões de cárie, restaurações ou FPE, sendo esta última associada principalmente a opacidades marrom-amareladas nos dentes posteriores. Sugerimos que estudos de prevalência de cárie dentária que utilizam o índice ceod/CPO-D avaliem dentes hipomineralizados separadamente, pois sua necessidade de tratamento pode não ter relação com experiência de cárie, assim como o ICDAS não é um bom índice a ser aplicado em dentes com esse tipo de defeito qualitativo no esmalte dentário. (AU)

The aims of the present study were: 1) to evaluate the affection patterns of Molar Incisor Hypomineralization defects between dental arches and sides of the mouth in relation to the presence of symmetry of affection, phenotypes and the involvement of other groups of teeth; 2) to relate the color and location of the affected surfaces to the presence of post-eruptive breakdowns (PEB), caries lesion and restorations; 3) to verify the influence of PEB and opacities on the indexes of decayed, missing and filled teeth (dmf-t / DMF-T) and International Caries Detection and Assessment System (ICDAS), respectively. This is a cross-sectional observational study carried out at the Pediatric Dental clinics of the Faculty of Dentistry of the Federal University of Rio de Janeiro. Two studies were carried out (study 1: n = 35; study 2: n = 39), with a convenience sample of children and adolescents aged 3 to 14 years, who had at least one first permanent molar (FPM) or second primary molar (SPM) with signs of hypomineralization, according to the European Academy of Paediatric Dentistry. For study 1 the Chi-square, Fisher's exact, Student's t and Pearson's correlation tests were used to verify the possibility of associations between symmetry, color, location and clinical situation (p≤0.01). In study 2, to check the influence of PEB and opacities on the dmf-t / DMF-T and ICDAS indexes, the Chi-square test was used. There was no symmetry among the number of opacities, color and severity (phenotypes). The average number of affected teeth in patients with FPMs or SPMs with severe defects (5.63 ± 2.83) was higher (p<0.01) than in patients with FPMs or SPMs with mild defects (2.62 ± 0.92). The number of surfaces affected in FPMs or SPMs was associated with canine involvement. Yellowish-brown opacities in posterior teeth were related to the presence of PEB (p<0.01). The presence of hypomineralization in a region of masticatory effort was correlated with caries, restorations or PEB (p = 0.0014). Dmf-t / DMF-T and ICDAS tend to overestimate the relationship between hypomineralization and tooth decay due to similar characteristics between the two conditions (dentin exposure by PEB and opacities). It is concluded that the presence of hypomineralization occurred symmetrically between arches and hemiarchs, although not associated with the same phenotypes. The number of surfaces affected in FPMs or SPMs was associated with the presence of signs of hypomineralization in canines. Opacities on surfaces located in regions of masticatory effort showed a positive correlation with the presence of caries lesions, restorations or PEB, the latter being mainly associated with yellow-brown opacities in the posterior teeth. We suggest that studies on the prevalence of dental caries evaluate hypomineralized teeth separately, as their need for treatment may be unrelated to caries experience, just as the ICDAS is not a good index to be applied to teeth with this type of qualitative defect in tooth enamel. (AU)