Effects of Infantile Hypophosphatasia on Human Dental Tissue.

Hypophosphatasia (HPP) is an inherited, systemic disorder, caused by loss-of-function variants of the ALPL gene encoding the enzyme tissue non-specific alkaline phosphatase (TNSALP). HPP is characterized by low serum TNSALP concentrations associated with defective bone mineralization and increased fracture risk. Dental manifestations have been reported as the exclusive feature (odontohypophosphatasia) and in combination with skeletal complications. Enzyme replacement therapy (asfotase alfa) has been shown to improve respiratory insufficiency and skeletal complications in HPP patients, while its effects on dental status have been understudied to date. In this study, quantitative backscattered electron imaging (qBEI) and histological analysis were performed on teeth from two patients with infantile HPP before and during asfotase alfa treatment and compared to matched healthy control teeth. qBEI and histological methods revealed varying mineralization patterns in cementum and dentin with lower mineralization in HPP. Furthermore, a significantly higher repair cementum thickness was observed in HPP compared to control teeth. Comparison before and during treatment showed minor improvements in mineralization and histological parameters in the patient when normalized to matched control teeth. HPP induces heterogeneous effects on mineralization and morphology of the dental status. Short treatment with asfotase alfa slightly affects mineralization in cementum and dentin. Despite HPP being a rare disease, its mild form occurs at higher prevalence. This study is of high clinical relevance as it expands our knowledge of HPP and dental involvement. Furthermore, it contributes to the understanding of dental tissue treatment, which has hardly been studied so far.

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

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

Root caries lesions inhibition and repair using commercial high-fluoride toothpastes with or without tri-calcium phosphate and conventional toothpastes containing or not 1.5% arginine CaCO3: an in situ investigation.

OBJECTIVES: This double-blind, crossover, and in situ study evaluated the effect of commercial high-F toothpastes with or without functionalized ß-tri-calcium phosphate (fTCP) and conventional-F toothpaste containing or not 1.5% arginine-CaCO3 in preventing and repairing root caries-like lesions. METHODS: Twelve volunteers wore palatal appliances containing sound (S) and pre-demineralized (PD) bovine root dentin blocks in 4 phases of 14 days/each. They used F toothpastes, 3×/day: (i) 1,450 µg F/g (conventional-F); (ii) 1,450 µg F/g + 1.5% arginine-CaCO3 (conventional-F + arginine/CaCO3); (iii) 5,000 µg F/g (high-F); and (iv) 5,000 µg F/g (high-F + fTCP). Sucrose solution (20%) was dropped 8×/day on the S blocks. The demineralization in the S blocks and the remineralization in the PD ones were estimated by % of surface hardness difference (%SH-S) and % of SH recovery (%SHR-PD), respectively. Caries lesion area (ΔS) was determined in the blocks. Statistical analyses were performed by one-way ANOVA/Kruskal-Wallis and multiple comparisons tests (p < 0.05). RESULTS: Both high-F toothpastes presented similar effect to prevent early caries lesions and it was higher than conventional-F + arginine/CaCO3. All treatments resulted in significantly lower ΔS values compared with conventional-F toothpaste (p < 0.0001). High-F + fTCP showed non-significantly higher preventive and reversible effect compared to high-F. The effect of conventional-F + arginine/CaCO3 was similar to high-F and lower than high-F + fTCP in preventing and reverting in-deep caries lesions. CONCLUSIONS: Overall, high-F toothpastes seem to be more effective and interesting feasible strategy for both prevention and remineralization actions in root dentin. CLINICAL RELEVANCE: With the trend of increasing dentin root caries, this study brings new evidences about the preventive and repair effect of high-F toothpastes with or without fTCP in root caries and support the use of arginine in toothpastes.

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)

[Characteristics of dental hard tissues in chronic kidney disease: morphology, chemical composition, possibilities of remineralizing therapy]. / Kharakteristika tverdykh tkanei zubov pri khronicheskoi bolezni pochek: morfologiia, khimicheskii sostav, vozmozhnosti remineralizuiushchei terapii.

The aim of the work was an assessment of the morphological structure and chemical composition of dental hard tissues in persons suffering from chronic kidney disease and the effectiveness of remineralizing therapy in them. The study of the morphological structure and chemical composition of dental hard tissues in individuals suffering from chronic kidney disease and the effectiveness of 6 weeks of remineralizing therapy in the course of individual oral hygiene in combination with the intake of vitamin-mineral complex was conducted by means of ABT-55 electron microscope (Japan) combined with a LinkAN-10 000/S85 microprobe (United Kingdom) in comparison with persons without somatic pathology. It has been established that in people suffering from chronic kidney disease dental hard tissues morphological features were determined by their pathological changes due to carious process or non-carious lesions. In chronic kidney disease a significant decrease in the level of mineralization in both enamel and dentin was found, which was most pronounced in patients with chronic renal failure and did not depend on whether they received hemodialysis. The use of remineralizing therapy in people with chronic kidney disease within the framework of individual oral hygiene combined with a vitamin-mineral complex intake for 6 weeks significantly contributed to an increase in the Ca/P ratio in tooth enamel and may be seen as a useful tool for prevention of dental hard tissues pathology in the patient's group.

Are hypomineralised lesions on second primary molars (HSPM) a predictive sign of molar incisor hypomineralisation (MIH)? A systematic review and a meta-analysis.

OBJECTIVES: Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) involve qualitative structural developmental anomalies of tooth enamel affecting the first permanent molars (and often incisors) and the second primary molars, respectively. A putative relationship between HSPM and MIH has been reported in the scientific literature. The aim was to determine whether children with HSPM are more likely to develop MIH. SOURCE: A systematic search using PubMed/Medline, Embase and Cochrane Library electronic databases for publications from 2001 to August 2017 investigating the link between MIH and HSPM was undertaken. STUDY SELECTION: Four reviewers selected the studies independently, extracted the data according to PRISMA statement, and assessed the bias risk with the Newcastle-Ottawa Scale (NOS) criteria. RESULTS: From 645 potentially eligible studies, 14 were selected for full text analysis and 5 were included in the meta-analysis. Cross-sectional and cohort studies were reported and 4662 participants were included. The meta-analyses were performed with a random model calculated an OR total of 4.66 (95% CI 2.11-10.26; P < 0.001). The weighted mean of the co-occurrence of HSPM and MIH prevalence was 19.94%. DISCUSSION: The high heterogeneity (I2 = 88%) can be explained by the great variation present in number of participants and variable caries risk. Despite the limitations of the study, the presence of HSPM is predictive for MIH, with greater MIH prevalence in the presence of mild HSPM. CLINICAL SIGNIFICANCE: Early detection and preventive intervention could reduce MIH complications.

Avaliação da irradiação do Nd: YAG laser sobre esmalte dental, associada ou não a um fotoabsorvedor, na redução da desmineralização por cárie artificial / Evaluation of the irradiation of the Nd: YAG laser on dental enamel, associated or not to a photoabsorber, in the reduction of artificial caries demineralization

O objetivo deste estudo foi avaliar a eficácia de diferentes parâmetros de energia do Nd:YAG laser, associados ou não a um fotoabsorvedor na redução da desmineralização por cárie artificial, sobre a superfície de esmalte dental. De coroas de incisivos bovinos foram obtidos 80 espécimes circulares com 6 mm de diâmetro e 2 mm de altura (1 mm de esmalte e 1 mm de dentina), o esmalte foi polido com lixas de carbeto de silício. Em cada espécime foi delimitada uma metade na qual o esmalte ficou exposto. As amostras foram avaliadas em Microdurômetro e FTIR para verificação inicial, e distribuídas de forma aleatória em oito grupos (n=10), que receberam os seguintes tratamentos de superfície sobre o esmalte: G1 (controle negativo): não recebeu tratamento de superfície; G2 (controle positivo): aplicação tópica de fluorfosfato acidulado 1,23% gel por 4 min; G3 (Nd:YAG 60 mJ / pulso, 10Hz, 48 J/cm2 , não contato); G4 (fotoabsorvedor + Nd:YAG 60 mJ); G5 (Nd:YAG 80 mJ / pulso, 10Hz, 64 J/cm2 , não contato); G6 (fotoabsorvedor + Nd:YAG 80 mJ); G7 (Nd:YAG 100 mJ / pulso, 10Hz, 80 J/cm2 , não contato); G8 (fotoabsorvedor + Nd:YAG 100 mJ). Após os tratamentos as amostras foram submetidas ao ciclo de des-remineralização para indução artificial de cárie, sendo então avaliadas em Interferômetro de luz branca, Microdurômetro e FTIR. Os resultados de microdureza foram submetidos à Análise de variância (ANOVA) sob 2 fatores (laser e fotoabsorvedor); ao teste de Tukey e ao teste de Dunnett, com nível de significância de 5% (=0,05). Diferenças estatisticamente significantes foram obtidas no fator fotoabsorvedor individualmente e na interação entre os fatores laser e fotoabsorvedor. Houve menor porcentagem de perda de microdureza nos grupos com fotoabsorvedor comparados aos grupos sem fotoabsorvedor e no grupo G8 comparado aos demais grupos experimentais, o qual apresentou ainda média de microdureza semelhante ao grupo G2. Os dados do FTIR foram submetidos ao Teste T, com nível de significância de 5% (=0,05). Comparadas com G2 foram encontradas maiores concentrações de carbonato em G4, G6 e G8; de fosfato em G8; menor concentração de Amida I em G8 e maior relação Carbonato/Fosfato em G4 e G6. Os resultados de interferometria foram submetidos à ANOVA a três fatores de medidas repetidas, com nível de significância de 5% (=0,05). Houve diferenças estatisticamente significantes no fator fotoabsorvedor individualmente e no fator tempo. Concluiu-se que o emprego de fotoabsorvedor diminuiu a desmineralização, os parâmetros de Nd:YAG laser sem fotoabsorvedor foram menos efetivos que o flúor na prevenção da desmineralização, o parâmetro de 100 mJ do Nd:YAG laser com fotoabsorvedor foi tão efetivo quanto o flúor na redução da desmineralização e a aplicação do Nd:YAG laser, associado ou não ao fotoabsorvedor, não foi mais eficaz que o flúor na redução da desmineralização por cárie artificial(AU)

The aim of this study was to evaluate the effectiveness of different energy parameters of the Nd:YAG laser, associated or not to a photoabsorber in the reduction of demineralization by artificial caries, on the surface of dental enamel. From the crowns of bovine incisors, 80 circular specimens with 6 mm diameter and 2 mm height (1 mm of enamel and 1 mm of dentin) were obtained, the enamel was polished with silicon carbide sandpapers. In each specimen surface was delimited a half in which the enamel was exposed. The samples were evaluated in Microdurometer and FTIR for initial verification, and randomly distributed in eight groups (n = 10), which received the following surface treatments on the enamel: G1 (negative control): no surface treatment; G2 (positive control): topical application of acidulated fluorophosphate 1.23% gel for 4 min; G3 (Nd:YAG 60 mJ / pulse, 10 Hz, 48 J / cm2 , non-contact); G4 (photoabsorber + Nd:YAG 60 mJ); G5 (Nd:YAG 80 mJ / pulse, 10 Hz, 64 J / cm2 , non-contact); G6 (photoabsorber + Nd:YAG 80 mJ); G7 (Nd: YAG 100 mJ / pulse, 10 Hz, 80 J / cm2 , non-contact); G8 (photoabsorber + Nd:YAG 100 mJ). After the treatments, the samples were submitted to the deremineralization cycle for artificial induction of caries, and were then evaluated in White Light Interferometer, Microdurometer and FTIR. The microhardness results were submitted to Analysis of Variance (ANOVA) under 2 factors (laser and photoabsorber); to the Tukey test and the Dunnett test, with a significance level of 5% ( = 0.05). Statistically significant differences were obtained in the photoabsorber factor individually and in the interaction between the laser and photoabsorber factors. There was a lower percentage of microhardness loss in the photoabsorber groups compared to the non-photoabsorber groups and in the G8 group compared to the other experimental groups, which also presented a microhardness average similar to the G2 group. The FTIR data were submitted to the T test, with a significance level of 5% ( = 0.05). Compared with G2, higher concentrations of carbonate were found in G4, G6 and G8; phosphate in G8; lower Amide I concentration at G8 and higher Carbonate / Phosphate ratio at G4 and G6. The interferometry results were submitted to ANOVA under three factors of repeated measures, with a significance level of 5% ( = 0.05). There were statistically significant differences in the photoabsorber factor individually and in the time factor. It was concluded that the use of photoabsorber decreased the demineralization, the non-photoabsorber Nd:YAG laser parameters were less effective than fluoride in the prevention of demineralization, the parameter of 100 mJ of the Nd:YAG laser with photoabsorber was as effective as fluoride in the reduction of demineralization and the application of Nd:YAG laser, associated or not to the photoabsorber, was no more effective than fluoride in the reduction of artificial caries demineralization.5% ( = 0.05) (AU)

Efficacy of desensitizing products containing 8% arginine and calcium carbonate for hypersensitivity relief in MIH-affected molars: an 8-week clinical study.

OBJECTIVES: The objective of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 8 weeks combining a single in-office application and a homed-based program with desensitizing products containing 8% arginine and calcium carbonate. MATERIALS AND METHODS: Nineteen children with at least one MIH-affected molar with hypersensitivity were included. Hypersensitivity was assessed with an evaporative (air) stimulus and a tactile stimulus. Each child received a single in-office treatment with a desensitizing paste containing 8% arginine and calcium carbonate (elmex Sensitive Professional desensitizing paste), followed by 8 weeks of brushing twice daily with a desensitizing toothpaste containing 8% arginine, calcium carbonate with 1450 ppm fluoride (elmex Sensitive Professional toothpaste), using the elmex Sensitive Professional toothbrush. Additionally, the corresponding mouthwash (elmex Sensitive Professional mouthwash) was used. Clinical assessments were made at baseline, immediately after the in-office treatment and after 1, 2, 4 and 8 weeks of brushing twice daily. RESULTS: Fifty-six molars with an air blast hypersensitivity score of 2 or 3 (Schiff Cold Air Sensitivity Scale) were included. Application of the desensitizing paste decreased hypersensitivity significantly immediately and throughout the 8 weeks recalls (p < 0.001). CONCLUSIONS: In conclusion, 8% arginine and calcium carbonate were able to reduce hypersensitivity successfully during this 8-week trial. CLINICAL RELEVANCE: Hypersensitivity is a major complaint in patients with MIH. This is the first study evaluating the desensitizing effect of a desensitizing paste containing 8% arginine and calcium carbonate in patients with MIH.

Impacto de la hipomineralización incisivo molar en la experiencia de caries en escolares de 6-12 años en Santiago, Chile / Molar incisor hypomineralisation and its impact on caries experienced by 6-12 year-old schoolchildren from Santiago, Chile

Objetivo: El objetivo de este estudio fue determinar las consecuencias clínicas expresadas en índices COPD y ceod y su relación con la presencia de hipomineralización incisivo molar (HIM) en una población de escolares de 6 a 12 años de la provincia de Santiago. Método: Este estudio de corte transversal fue realizado en 851 escolares de 6 a 12 años de la provincia de Santiago, quienes fueron evaluados por 2 dentistas calibrados. Con consentimiento de los tutores legales, los escolares fueron examinados, y se utilizaron los criterios diagnósticos para HIM de la Academia Europea de Odontopediatría (EAPD). La historia de caries fue determinada con COPD/ceod de acuerdo a los criterios de la OMS. Los datos fueron recolectados en una ficha especialmente diseñada para esto. Los datos fueron analizados con test «t¼ para muestras individuales (considerando p < 0,05). Resultados: Los escolares afectados por HIM tuvieron una media de COPD de 0,91 (±1,21) y una media de ceod de 1,98 (±2,48), el cual fue mayor que el COPD y ceod de escolares sin HIM (0,41 [±0,95] y 1,34 [±2,15] respectivamente). La diferencia entre ambos grupos fue estadísticamente significativa para COPD (p < 0,000) y ceod (p = 0,002). Conclusiones: Escolares de la provincia de Santiago de 6 a 12 años afectados con HIM presentaron mayor COPD/ceod que escolares sin HIM.

Objective. The aim of this study was to determine the clinical consequences, expressed in DMFT and dmft, and their relationship with Molar Incisor Hypomineralisation (MIH) in a population of schoolchildren of 6 to 12 years old in the Santiago Province. Method: A cross-sectional study was conducted on 851 schoolchildren between 6-12 years old from the Santiago Province were examined by two calibrated examiners. With informed consent from their parents, the schoolchildren were examined, and the European Academy of Paediatric Dentistry (EAPD) diagnostic criteria was used for MIH detection. Caries history was assessed with the DMFT/dmft score according to WHO criteria. Data was collected with a form specially designed for this study. Data was analysed using Student's t-test for individual samples and a post-hoc Bonferroni (P < .05). Results: The mean DMFT score in the MIH-affected schoolchildren was 0.91 (±1.21), with a mean dmft score of 1.98 (±2.48), which were greater than the scores in the non-MIH affected schoolchildren (mean DMFT score 0.41 [±0.95] and mean dmft 1.34 [±2.15]). The differences between DMFT and dmft scores in the two groups were statistically significant (P < .000 and P = .002, respectively). Conclusions: Schoolchildren of Santiago Province of 6-12 year old diagnosed with MIH had higher DMFT/dmft scores compared to schoolchildren not affected with MIH.

Síndrome de hipomineralización incisivo-molar / No disponible

No disponible

Avaliação de fatores preditores, do perfil microbiológico salivar e da ocorrência de fratura pós-eruptiva do esmalte em pacientes com hipomineralização de molares e incisivos / Evaluation of predictor factors, microbiological profile in saliva and post-eruptive enamel breakdown in patients with Molar-incisor hypomineralization

O objetivo do presente trabalho foi realizar avaliações de etiologia, perfil microbiológico e longitudinal, visando observar fatores relacionados à ocorrência de hipomineralização de molares e incisivos (HMI), o risco de cárie e a evolução clínica dos defeitos de esmalte. No estudo 1(caso-controle) se investigou-se a presença de hipomineralização de molares decíduos (HMD) pode ser utilizada como um preditor clínico de HMI em 162 pacientes (65 casos e 97 controles) com idade entre 5-12 anos, como também a associação entre HMI e fatores como baixo peso ao nascer e uso de antibióticos durante o primeiro ano de vida. Como resultado, a presença de HMD desempenha um importante papel como preditor, aumentando em 2,77 vezes a chance de ocorrência de HMI (IC 95%: 1,20 ­ 6,39). Embora HMI seja mais frequente em crianças com baixo peso ao nascimento (p: 0,036), este fator pode não aumentar as chances de ocorrência de HMI significantemente (OR: 2,82; IC 95%: 1,00 ­ 7,66). O uso de antibióticos durante o primeiro ano de vida aumentou em 2,97 a chance de desenvolver HMI (OR: 2,97; IC 95%: 1,43 ­ 6,16). Já no estudo 2 avaliou-se o risco de cárie em 20 pacientes com HMI severa (7-13 anos), observando a correlação da contagem de Streptococcus mutans (SM) e de Lactobacillus spp., do fluxo salivar e da experiência de cárie na dentição decídua com o índice CPO. O grupo apresentou CPO-D e CPO-S médiosde 2,8 (DP: 1,1) e7,3 (DP: 4,7), respectivamente. Cada dente cariado apresentava, em média, 2,5 (DP: 1,1) superfícies afetadas. Em relação ao componente "cariado" ­ cárie ativa ­ do CPO, observou-se uma média de 1,9 (DP: 2,0). Todos os pacientes apresentaram boa capacidade tampão da saliva, e não houve diferença estatisticamente significante no CPO-D ou no CPO-S médios em relação às variáveis analisadas. No estudo 3 foi realizada uma avaliação longitudinal da evolução da HMI em 58 crianças com média de idade de 8,8 anos, observando a coloração, localização e incidência de força sobre cada superfície dentária, de modo a estimar o risco de fratura pós-eruptiva. Considerando a fratura em dentina (FD) como desfecho, 14% das opacidades branco-creme (OP-BC), 26,9% das opacidades amarelo-marrons (OP-AM) e 46,9% das fraturas em esmalte (FE) evoluíram. A progressão foi significativamente mais frequente dentre as OP-AM em comparação com as OP-BC, sendo altamente significativa quando se considerou fratura a partir da FE (p<0,0003). Já a progressão para FE não foi estatisticamente diferente entre superfícies expostas ou não expostas ao atrito mastigatório tanto para as OP-BC (p=0,15), como para as OP-AM (p=0,51). O mesmo ocorreu quando se considerou a progressão para FD dentre as OP-BC (p=0,36), OP-AM (p=0,82) ou FE (p=0,27). A chance de ocorrência de fratura das opacidades demarcadas foi 3,55 (IC 95%: 1,75 ­ 7,20) e 2,27 (IC 95%: 1,06 ­ 4,86) vezes mais alta quando a opacidade era amarela-marrom, considerando FE e FD, respectivamente. Com base nos resultados, HMI ainda representa um desafio na clínica odontológica e o conhecimento dos fatores apresentados podem auxiliar no estabelecimento de tratamentos adequados com bons prognósticos.

The aim of the present study was to evaluate the etiology, microbiological profile and longitudinal follow up to observe molar-incisor hypomineralization (MIH) related factors, caries risk and clinical evolution of enamel defects. In the study 1 (case-control), the presence of deciduous molar hypomineralization (DMH) as a predictor for MIH was analyzed in 162 patients (65 case and 97 controls), with age between 5-12 years old, as well as the association between HMI and risk factors as low birth weight and antibiotics intake during the first year of life. As a result, DMH plays an important role as a predictor, increasing in 2.77 times de chance of MIH occurrence (95% CI: 1.20 ­ 6.39). Although MIH is more frequent in children with low birth weight (p: 0.0036), this factor could not increase significantly the chance of MIH occurrence (OR: 2.82; 95% CI: 1.00 ­ 7.66). Antibiotics intake during the first year of life showed an increased chance of MIH occurrence in 2.97 times (95% CI: 1.43 ­ 6.16). In the study 2, the analysis of caries risk in 20 patients with severe MIH (7-1 years old) was made to observe the association between Streptococcus mutans (SM) and Lactobacillus spp. counts, salivary flow and caries experience in deciduous teeth with DMF index. The study group showed 2.8 (SD: 1.1) and 7.3 (SD: 4.7) DMF-T and DMF-S, respectively. Each caries tooth had 2.5 (SD: 1.1) affected surface. Analyzing only the decayed component of DMF index, a mean of 1.9 (SD: 2.0) of decayed surface was observed. All patients showed good salivary buffer capacity and there were no statistical difference between DMF-T and DMF-S related to the variables. In study 3, MIH longitudinal evaluation was performed in 58 children with mean age of 8.8 years, observing the color, location and force incidence to estimate the risk of post-eruptive fracture in those affected teeth. Considering dentine fracture (FD) as outcome, 14% of white-cream (OP-BC), 26.9% of yellow-brown (OP-AM) opacities and 46.9% of enamel fracture broke. Progression was significantly frequent in OP-AM, compared to OP-BC, and highly significant when fracture was considered from FE (p<0.0003). Progression to FE was not statistically different between surfaces under masticatory forces or not for OP-BC (p=0.15), and for OP-AM (p=0.51). The same happened considering progression to FD in OP-BC (p=0.36), OP-AM (p=0.82) or FE (p=0.27). The chance of fracture occurrence from demarcated opacities was 3.55 (95% CI: 1.75 ­ 7.20) and 2.27 (95% CI: 1.06 ­ 4.86) times higher when OP-AM, considering FE and FD, respectively. Based on these results, MIH remains a challenge in clinical dentistry and the knowledge of these factors can help to establishment appropriated treatments and good prognosis.

Dental demineralization and caries in patients with head and neck cancer.

Concurrent chemoradiation (CCR) therapy is a standard treatment for patients with locally advanced head and neck cancer (HNC). It is well documented that CCR causes profound acute and late toxicities. Xerostomia (the symptom of dry mouth) and hyposalivation (decreased salivary flow) are among the most common treatment side effects in this cohort of patients during and following treatment. They are the result of radiation-induced damage to the salivary glands. Patients with chronic hyposalivation are at risk for demineralization and dental cavitation (dental caries), often presenting as a severe form of rapidly developing decay that results in loss of dentition. Usual post-radiation oral care which includes the use of fluoride, may decrease, but does not eliminate dental caries associated with radiation-induced hyposalivation. The authors conducted a narrative literature review regarding dental caries in HNC population based on MEDLINE, PubMed, CLNAHL, Cochrane database, EMBASE, and PsycINFO from 1985 to 2014. Primary search terms included head and/or neck cancer, dental caries, dental decay, risk factor, physical symptom, physical sequellea, body image, quality of life, measurement, assessment, cost, prevention, and treatment. The authors also reviewed information from National Institute of Dental and Craniofacial Research (NIDCR), American Dental Association (ADA), and other related healthcare professional association web sites. This literature review focuses on critical issues related to dental caries in patients with HNC: potential mechanisms and contributing factors, clinical assessment, physical sequellea, negative impact on body image and quality of life, potential preventative strategies, and recommendations for practice and research in this area.

Clinical assessment of non carious cervical lesion using swept-source optical coherence tomography.

Non-carious cervical lesions (NCCLs) involve various forms of tooth loss with different etiologies. This study aimed to utilize swept-source optical coherence tomography (SS-OCT) at 1300 nm wavelength range in vitro and in vivo to evaluate and clarify the mechanism of NCCLs. In the in vitro phase, a dentin attenuation coefficient (µt ) derived from the SS-OCT signal at NCCL was compared with mineral loss obtained from transverse microradiography (TMR) to determine a µt threshold to discriminate demineralization of cervical dentin in vivo. In the clinical study, 242 buccal surfaces were investigated in 35 subjects. Presence and dimensions of NCCLs, cervical cracking and the degree of demineralization at the exposed cervical dentin were determined using SS-OCT. Dentin demineralization was observed in 69% of NCCLs. SS-OCT results confirm that dentin mineral loss and occlusal attrition were associated with larger NCCLs, and can be considered as an etiological factor in formation and progress of these lesions. (A) We determined the attenuation coeffcient (µt ) threshold of SS-OCT signal for the detection of demineralization (1.21) from in vitro study. DEM: demineralized dentin, sound: sound dentin. (B) Using the µt threshold, we observed NCCLs in vivo to detect the demineralization in cervical dentin. SS-OCT scanning was performed along the red line. (C) SS-OCT image obtained along the red line in B. In SS-OCT, brightness of dentin beneath the NCCL was increased (arrow) compared with intact zone. The cervical dentin was slightly demineralized (µt : 1.25). e: enamel, d: dentin, g: gingiva.

Masking white spots of enamel in caries lesions with a non-invasive infiltration technique in vitro.

We investigated the treatment effect of non-invasive infiltration on early caries caused by different degrees of enamel demineralization. Forty specimens of early enamel caries were prepared and divided into low and high demineralization groups. After treatment with non-invasive infiltration, the specimens were placed under cariogenic conditions. Color measurements were determined using a spectrophotometer 4 times to obtain chromatism values (ΔE1-ΔE4), including before and after production of artificial caries, and after infiltration treatment and re-demineralization. The effects of color change on early caries using non-invasive infiltration were compared between the 2 demineralization groups. Color differences before the production of artificial caries and after infiltration treatment and re-demineralization could not be distinguished by direct observation. Color differences after the production of artificial caries and after infiltration treatment and re-demineralization could be distinguished by direct observation. There were no significant differences in the 4 chromatism values (ΔE1-ΔE4) between the 2 groups. Non-invasive infiltration showed an excellent ability to mask white spot lesions and maintained high color stability. Treatment of high and low demineralization of enamel had the same masking effect.

Staining of dentin from amalgam corrosion is induced by demineralization.

PURPOSE: To evaluate the effect of artificial demineralization upon color change of dentin in contact with dental amalgam. METHODS: Sound human molars (n = 34) were embedded in resin and coronal enamel was removed. Dentin was exposed to artificial caries gel (pH 5.5) at 37 degrees C for 12 weeks (n = 24). Non-demineralized teeth served as controls (n = the 10). A dispersive high-Cu amalgam or conventional low-Cu amalgam was condensed onto dentin surfaces of all groups. After 10 weeks storage in saline, amalgam was removed and teeth were cut into three slices. Surfaces were inspected under optical microscopy and photographed. RESULTS: Penetration of black pigments was observed in dentin underneath both high-Cu and low-Cu amalgams in demineralized specimens. Black deposits were unevenly distributed and observed predominantly in dentin near to pulp horns. Discoloration was not limited to outer demineralized dentin but extended beyond this zone. Evenly distributed bluish-green discoloration was observed underneath all high-Cu amalgam specimens independent of demineralization.

An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren.

BACKGROUND: Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment. AIMS: To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation. DESIGN: Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. RESULTS: Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. CONCLUSION: Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.

Infantile loss of teeth: odontohypophosphatasia or childhood hypophosphatasia.

Hypophosphatasia is a hereditary disorder characterized by a deficiency of serum and bone alkaline phosphatase (ALP) activity and defective skeletal mineralization. It is caused by a loss of function mutations in the tissue nonspecific ALP gene (TNSALP) encoding the tissue nonspecific alkaline phosphatase. A 4-year-and-8-month-old girl presented with premature exfoliation of the anterior incisors and canines. Very low ALP level (27 IU/ml) suggested the diagnosis of hypophosphatasia, which was supported by an elevated urine phosphoethanolamine/Cr of 84 µmol/mmol (reference range, <25 µmol/mmol) and serum pyridoxal-5'-phosphate of 393 µg/L (reference range, 3.6-18 µg/L). The phenotype of the patient was subsequently classified as mild childhood hypophosphatasia. TNSALP gene sequencing revealed the homozygous c.382 G > A (p.V128M) mutation. This mutation was previously observed in a series of patients with severe hypophosphatasia, pointing out the possible role of other genetic or environmental factors in the modulation of the hypophosphatasia phenotype.

Increased susceptibility for white spot lesions by surplus orthodontic etching exceeding bracket base area.

INTRODUCTION: There is a paucity of information with regard to the susceptibility of iatrogenic white spot lesion formation after inattentive, surplus orthodontic etching with 30% phosphoric acid and the subsequent provision or absence of adequate oral hygiene. METHODS: Ninety sound enamel specimens were randomly allocated to 6 trial groups (n = 15 each) for etching with 30% phosphoric acid for either 15 seconds and standardized daily enamel brushing or no brushing, etching for 30 seconds with daily brushing or no brushing, or nonetched controls with brushing or no brushing. Nutritive acidic assaults were simulated by demineralization cycles 3 times per day for 1 hour with interim storage in artificial saliva. Lesion depths in terms of percentage of fluorescence loss (delta F, delta Q) and lesion extension compared with the baseline were assessed by using quantitative light-induced fluorescence after 2, 7, 14, 21, and 42 days. Etching duration, trial time elapse, and oral hygiene, as well as the significance of factor interactions, were analyzed with 3-way analysis of variance (α = 5%). RESULTS: The impact of the factors of enamel brushing, trial time elapse, and etching each had a comparably significant effect on lesion progression. The effect of surplus etching on white spot lesion formation was significantly enhanced by the simultaneous absence of enamel brushing and also the progression of trial time. The combination of 30 seconds of surplus etching with inadequate oral hygiene was especially detrimental. CONCLUSIONS: Excessive surplus orthodontic etching of the complete labial enamel surface, instead of the bracket bases only, must be avoided to prevent iatrogenic white spot lesions. Etching times not exceeding 15 seconds are favorable.

Dental developmental disturbances in 50 individuals with the 22q11.2 deletion syndrome; relation to medical conditions?

OBJECTIVE: The aims of the study were to examine tooth and enamel disturbances in individuals with 22q11.2 deletion syndrome and to analyze associations with medical conditions, birth characteristics and blood values of calcium and PTH. MATERIALS AND METHODS: Fifty individuals participated in the study (27 females, median age 10 years, range 1.5-44). Congenital absence of teeth was studied on orthopantomograms; 1148 teeth were examined, both clinically and radiologically, and enamel hypomineralizations and hypoplasias were recorded. Medical history and findings were recorded as part of a larger study on the manifestations of 22q11.2-deletion syndrome in Norway. RESULTS: Tooth agenesis was observed in 15% of study participants. Sixty-six percent of the participants and 26.0% of teeth presented with enamel disturbances. Of these, 12 individuals (24.0%) and 215 teeth (18.7%) had hypomineralizations and four individuals (8.0%) and 86 teeth (7.5%) had hypoplasias. Seventeen participants (34.0%) presented with both types of disturbance, but rarely in the same tooth. Only two teeth (0.17%) had both types of disturbance. Hypomineralizations were twice as frequent in permanent as in primary teeth. No correlations were found to medical conditions, except that participants with congenital cardiac anomalies presented with fewer total enamel disturbances and hypomineralizations in permanent teeth than those without. CONCLUSIONS: Enamel disturbances were frequently seen. There were more hypomineralizations than hypoplasias. Hypoparathyroidism and/or hypocalcemia are not clear etiological factors for enamel disturbances and there were no major correlations between medical conditions and enamel disturbances.