Insights into molar-incisor hypomineralisation in past populations: A call to anthropologists.

OBJECTIVE: Molar incisor hypomineralisation (MIH) is a developmental defect of enamel affecting the first permanent molars and often the incisors and affecting approximately 13% of the current population worldwide. Here, we aim to highlight potential differential diagnoses of MIH in archaeological collections (taphonomic discoloration, amelogenesis imperfecta, fluorosis, rachitic teeth, etc.). METHODS: Causative factors of dental discolourations are identified through a literature review. RESULTS: In an archaeological context, the sediments contained in the burial soil can lead to tooth discoloration. Taphonomic staining of the dentition may have a similar appearance to enamel hypomineralisation, and thus is a confounding factor that has the potential to cause miscalculation of the true prevalence of MIH within archaeological collections. Some rare medieval cases are reported in the modern literature but without microanalysis, misdiagnosis is possible. The aetiological factors of MIH are unknown but probably follow the multifactorial model involving systemic medical and genetic factors. CONCLUSIONS: Systematic detection and diagnosis of MIH during anthropological studies is therefore of great interest. SIGNIFICANCE: The hypotheses that only contemporary agents are causative factors of MIH could be refuted by the discovery of individuals living before medication or pollutants. The identification of MIH in a group of individuals also provides information regarding the health status of a population and reflects stress occurring during the period of mineralisation of the first permanent molars after secretion of the enamel matrix. LIMITATIONS: Taphonomic alterations of archaeological remains prevent MIH diagnosis. SUGGESTIONS FOR FUTURE RESEARCH: MIH diagnosis can be difficult in archaeological series and further non-destructive methods (microtomography, elemental analyses, etc.) are required.

Molar Incisor Hypomineralization in adolescents and adults and its association with facial profile and occlusion.

OBJECTIVES: To date, there are no data available in the scientific literature about the diagnosis of Molar Incisor Hypomineralization (MIH) in adults. We aimed to assess the MIH prevalence and clinical characteristics in adolescents and adults and its association with facial profile and occlusion. MATERIALS AND METHODS: In this cross-sectional study, permanent teeth were evaluated in 275 patients between the ages of 12 and 49 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index. Statistical analyses were performed using chi-square, Fisher's tests, and ordinal logistic regression. RESULTS: MIH was observed in 12.73% of all patients. The most commonly affected teeth were permanent molars, while incisors, premolars, and canines were less affected. MIH usually appears as demarcated opacities, with less than one-third of the tooth affected. There was no association between severe defects and facial profile and occlusion, but rather with the higher age of the participants. CONCLUSION: Enamel hypomineralization mainly affects the first and second permanent molars, but it could also be observed in the third molars, although it is not associated with the orthodontic characteristics investigated. CLINICAL RELEVANCE: This is the first study to highlight the prevalence of MIH in adults. This result showed the importance of other specialists beyond Pediatric Dentistry in the diagnosis of this defect. In addition, hypomineralization of other permanent teeth (canines, premolars, and second molars) has been described previously in other studies, but this is the first to identify MIH in third molars.

Prevalencia de mancha blanca en dentición temporaria en el Hospital de Odontología Infantil Don Benito Quinquela Martín / Prevalence of white spot in temporary dentition at Don Benito Quinquela Martin Children's Dentistry Hospital

Introducción: La caries dental es una enfermedad infecciosa y multifactorial, que co- mienza por una desmineralización del esmalte producida por la acción de ácidos generados por bacterias presentes en el biofilm dental. Estas lesiones se inician como manchas blancas (MB) y es el único estadio de la caries dental capaz de ser revertido mediante la aplicación profesional de agentes remineralizantes, por lo que es fundamental la detección y tratamiento temprano de las mismas. Objetivo: Determinar la prevalencia de manchas blancas en la dentición temporaria de los niños atendidos en el Servicio de Clínica y Orientación del Hospital de Odontología Infantil (HOI) «Don Benito Quinquela Martín¼. Materiales y métodos: Se evaluó una muestra de 94 niños con dentición temporaria, en el Servicio de Clínica y Orientación del HOI, teniendo en cuenta los ingresos y reingresos, durante el período comprendido entre septiembre de 2019 y febrero de 2020. Resultados: La prevalencia de manchas blancas de un total de 94 niños evaluados fue del 55 %. De los pacientes que presentaron MB, el 59 % fue de sexo masculino y el 41 % de sexo femenino. La media de edad fue de 4.77 años. De los pacientes atendidos, 73 concurrieron por primera vez y 21 pacientes fueron reingresos. Conclusión: La prevalencia de manchas blancas en la muestra evaluada de niños atendidos en el Servicio de Clínica y Orientación del HOI fue del 55 %. Este resultado sugiere la necesidad de continuar y potenciar la promoción de la salud bucal, no solo como herramienta estratégica para brindar conocimientos acerca de los beneficios de una correcta higiene oral y una dieta saludable, sino también como factor de prevención en cuanto a la aparición de lesiones de caries y posteriores consecuencias adversas (AU)

Introduction: Dental caries is an infectious and multifactorial disease that begins with the demineralization of the enamel produced by the action of acids generated by bacteria in the dental biofilm. These lesions start as white spots (WS), and it's the only stage of dental caries capable of being reverted by the professional application of remineralizing agents. Hence, its early detection and treatment are essential. Objective: To determine the prevalence of white spots in the temporary dentition of children treated at the Clinical and Orientation Service of "Don Benito Quinquela Martin" Children's Dentistry Hospital (CDH). Materials and methods: A sample of 94 children with temporary dentition was evaluated on admission and readmission at CDH's Clinical and Orientation Service between September 2019 and February 2020. Results: The prevalence of WS in 94 children evaluated was 55%: 59% of patients who presented WS were males, and 41% were females. The mean age was 4.77 years. Seventy-three patients seen attended for the first time, and the other 21 were readmissions. Conclusion: The prevalence of WS in children who attended CDH's Clinical and Orientation Service was relevant. This result indicates that we must continue and enhance oral health promotion as a strategy to give knowledge about good oral hygiene benefits, a healthy diet, and to prevent the appearance of caries lesions and subsequent consequences (AU)

Evaluation of tooth demineralization using laser-fluorescence in dental school patients undergoing orthodontic treatment: A clinical study.

BACKGROUND: Adverse effects can occur during orthodontic treatment. OBJECTIVE: To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time. METHOD: A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included. RESULTS: Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p> 0.05) was observed between enamel demineralization and length of time under orthodontic treatment. CONCLUSIONS: A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study.

Hypophosphatasia.

Hypophosphatasia (HPP) is a group of inherited disorders characterised by the impaired mineralisation of bones and/or teeth and low serum alkaline phosphatase (ALP) activity. It is caused by a mutation in the ALPL gene encoding the tissue-non-specific isoenzyme of ALP (TNSALP) resulting in a loss of function. The disease is highly heterogenous in its clinical expression ranging from stillbirth without mineralised bone to the mild form of late adult onset with symptoms and signs such as musculoskeletal pain, arthropathy, lower-extremity fractures, premature loss of teeth or an incidental finding of reduced serum ALP activity. A classification based on the age at diagnosis and the presence or absence of bone symptoms was historically used: perinatal, prenatal benign, infantile, childhood, adult and odontohypophosphatasia. These subtypes are known to have overlapping signs and complications. Three forms of HPP distinguishable by their genetic characteristics have been described: severe, moderate and mild. Severe forms of HPP (perinatal and infantile severe) are recessively inherited, whereas moderate HPP may be dominantly or recessively inherited. The biochemical hallmark of HPP is persistently low serum ALP for age and increase in natural substrates of TNSALP, pyridoxal 5'-phosphate and phosphoethanolamine supported by radiological findings. The diagnosis is confirmed by ALPL sequencing. A multidisciplinary team of experts is essential for the effective management. Calcium restriction is recommended in infants/children to manage hypercalcaemia. A targeted enzyme replacement therapy for HPP has become available and correct diagnosis is crucial to allow early treatment.

Enamel opacities in all other than Molar Incisor Hypomineralisation index teeth of adolescents.

BACKGROUND: There are scarce data on the hypomineralisation of other permanent teeth (HOPT) than the index teeth of Molar Incisor Hypomineralisation (MIH). AIM: To report on the prevalence and surface pattern of HOPT and seek associations with MIH. DESIGN: Representative samples of urban Greek 14-year-olds were examined in classroom with a dental mirror. Their enamel defects were recorded using EAPD criteria for MIH. Descriptive statistics and correlation tests for HOPT vs previously reported MIH findings in the same samples were applied. RESULTS: HOPT prevalence in 1156 consented adolescents was 22.9%. 148 (16.2%) of 912 no-MIH children had HOPT; 117 (48.1%) of the 244 MIH children had HOPT too (OR 3.0, 95% CI 2.4-3.6). There were more HOPT teeth per child in the MIH vs no-MIH children (P < .001). HOPT tooth frequency was as follows: second molar 33.7%, canine 25.7%, first premolar 23.6%, and second premolar 17.0%. Enamel breakdown was seen in 5.3% HOPT children. Vestibular to intraoral surface defect ratio differed between jaws (maxilla 187/88, mandible 149/17, P < .05). CONCLUSIONS: Hypomineralisation defects in the MIH non-index teeth collectively had comparable prevalence and tooth surface patterns to MIH, but much lower severity. MIH was predictor for HOPT.

ORAL HYGIENE IN CHILDREN WITH DISTURBANCES IN TOOTH FORMATION WHO WERE AFFECTED AS A CONSEQUENCE OF THE ChNPP ACCIDENT. / STAN GIGIIeNY POROZhNYNY ROTA U DITEI Z PORUShENNIaMY FORMUVANNIa ZUBIV, POSTRAZhDALYKh VNASLIDOK AVARIÏ NA ChAES.

OBJECTIVE: evaluation of oral hygiene to enhance the prophylaxis of complications specifically of dental caries inchildren with disturbances in tooth formation (DTF) who live on radiologically contaminated territories after theChornobyl NPP (ChNPP) accident. MATERIALS AND METHODS: Children aged 6-14 years (n = 1470) with DTF were the study subjects examined in 2012-2016. Among them there were (n = 528) residents of the zones III and IV of radiological contamination after theChNPP accident with 137Cs soil contamination density 1-15 Ci/km2. The effective radiation dose in them was notexceeding 1 mSv/year. The Green-Vermillion and Silness-Loe oral hygiene indices were assesses within clinicalexamination methods. RESULTS: The worth oral hygiene was revealed in children having got the DTF, compensated chronic diseases oforgans and systems, and in those with burdened radiation history. The Green-Vermilion and Silness-Loe indices were1.7 ± 0.51 and 1.65 ± 0.46 respectively. CONCLUSIONS: A significant deterioration in oral hygiene confirmed by the highest values of the Green-Vermillion index (1.7 ± 0.51; p < 0.001 - «unsatisfactory oral hygiene¼ criterion) and Silness-Loe index (1.65 ± 0.46; p < 0.001 -«poor oral hygiene¼ criterion) was found in children with DTF aged 6-14 years being residents of contaminated areasas a result of the Chernobyl accident. The revealed deterioration may be due to a set of negative factors, includingthe impact of ionizing radiation in low doses and peculiarities of social status. Results of the questioning of surveyed pediatric contingents both having got an DTF and with no defects of the hard tissues of teeth indicate aninsufficient level of knowledge and skills in hygienic care of oral cavity regardless of the area of residence.Development of a set of measures to prevent the DTF complications in children should be carried out taking intoaccount the state of oral hygiene, level of knowledge and skills in oral care, and include the use of hygiene products, namely toothpastes and anti-caries mouthwashes.

Prevalence of Molar-Incisor Hypomineralization and Caries in Eight-Year-Old Children in Croatia.

The aim of this study was to detect molar-incisor hypomineralization (MIH) and caries prevalence in eight-year-old children with early mixed dentition in Eastern Croatia. There is a lack of data on MIH in Croatia. There were 729 children examined in total: 356 (48.83%) were female and 373 (51.16%) were male. The presence of MIH was found in 95 children, the prevalence of MIH was 13%, and the remaining 634 (87%) did not have any changes associated with MIH. The prevalence of caries overall in the population of examined children was 11.48%. In the group of children with MIH, the prevalence of caries was 24.14%, while in the group of children with no MIH, the prevalence of caries was 11.18%. Teeth had a Decayed, Missing, and Filled Teeth (DMFT) index of 1.2, the value of the SiC index was 1.4, and the decayed, missing, and filled teeth (dmft) index for deciduous teeth was 5.8. Children with MIH had a caries index of DMFT 2.1, and the value of the SiC index was 2.6. The index of caries for non-MIH children was DMFT 1.1 and the SiC index was 1.2. MIH prevalence in Croatia is more common in girls than in boys. MIH has a significant impact on children's development and is a major factor in the occurrence of caries.

Hipomineralización en dentición temporal: ¿factor predictivo de him? / No disponible

La terminología hipomineralización incisivo-molar (HIM) fue descrita por primera vez en 2001 para explicar los defectos de desarrollo cualitativos demarcados del esmalte, que afectan a uno o más molares permanentes, con o sin participación de los incisivos per-manentes1. En los últimos años, las investigaciones han dado lugar a informes de lesiones comparables en segundos molares temporales hipomineralizados, sin embargo, se desconoce si la presencia de opacidades demarcadas en los caninos temporales también puede asociarse con el HIM1-3. Da Silva y cols., en 2017, son los únicos autores hasta el momento que relacionan hipomineralizaciones en segundos molares temporales (HSPM) y caninos temporales (HPC)3. La prevalencia de HSPM varía dependiendo de los países entre 2,9% a un 21,8% 3,7.Se puede esperar que las causas de los defectos de hipomineralización en los segundos molares temporales sean las mismas que en los dientes permanentes, si ocurren conco-mitantemente a la calcificación de su corona, la cual comienza alrededor de la decimooctava semana de gestación 4-7. Se presenta el caso de un paciente infantil, de 6 años, que acudió a consulta para revisión odontológica. Tras la exploración, se observó la presencia de anomalías del color y estructura en: todos los segundos molares y caninos temporales, así como en los primeros molares temporales superiores y primer molar temporal inferior izquierdo (Figuras 1-6). La posterior exploración radiográfica mostró hallazgos patológicos localizados en 54, 64, 65, 74, 75, 84, 85 (Figuras 7-9). El tratamiento supone un desafío ya que es frecuente que los dientes afectados presenten afectación pulpar, además de hipersensibilidad y descomposición post*eruptiva. Esta relación podría sugerir como factor predictivo de aparición de HIM, la presencia HSPM y HPC, así podrían implementarse las medidas de prevención y control con intervalos más frecuentes en estos pacientes

No disponible

Fatores ambientais e variações genéticas nos genes AMBN, ENAM, KLK4, IRF6, TFGα em pacientes com hipomineralização molar incisivo / Environmental factors and genetic variations in the AMBN, ENAM, KLK4, IRF6, TFGα in patients with incisor molar hypomineralization

Trata-se de uma tese composta por quatro estudos, com o objetivo de avaliar possíveis fatores etiológicos (ambientais e genéticos) associados a presença de Hipomineralização Molar Incisivo (HMI) através de (a) : um estudo observacional transversal para verificar a prevalência de HMI na amostra estudada, junto com uma revisão bibliográfica da prevalência desta condição na população brasileira (objetivo-I); associação de fatores ambientais (durante o período gestacional e nos primeiros anos de vida) relacionados à presença de HMI e a influência destes fatores com a gravidade dessa condição (objetivo-II); associação dos polimorfismos de único nucletídeo (SNPs) localizados nos genes ameloblastina (AMBN), enamelina (ENAM) e calecreína com HMI, além da possível susceptibilidade dos SNPS com à cárie dentária (objetivo-III) e a interação entre fatores ambientais e as variações genéticas nos SNPs localizados nos genes fator 6 regulator de interferon (IRF6) e fator de crescimento transformador alfa (TGFα) estudados em amostras no Rio de Janeiro, Curitiba e turca (Istambul) (objetivo-IV). As coletas de dados do presente estudo foram realizadas em duas etapas: clínica e laboratorial. Os resultados encontrados foram: (I) uma alta heterogeneidade entre os estudos (Q = 52,81, p < 0.01, I2 = 98) com a prevalência final de HMI de 13.48% na população barasileira; (II) as intercorrências na gestação e o uso de medicamentos na primeira infância tiveram uma associação significativa com a presença de HMI (OR = 3,01; 95% CI = 1,74- 8,42; p= 0,014; OR = 3,55; 95% CI = 1,35-10,57; p = 0,019 ), entretanto esses fatores não influenciaram a gravidade dessa condição (p>0,05); (III) houve um resultado significativo no SNP rs2235091 localizado no gene KLK4 com a HMI (p<0,001), e os polimorfismos rs4694075 (AMBN) e rs3796704 (ENAM) mostraram associação com a cárie dentária (p<0.05); (IV) a amostra do Rio de Janeiro apresentou uma interação entre os SNPs rs1523305 (TGFα) e rs642961 (IRF6) (p = 0,03) e entre rs2073487 (IRF6) e rs2902345 (TGFα) (p = 0,04). Além disso, no estudo de Istambul houve uma associação entre o SNP rs930655 (TGFα) com todos os marcadores do gene IRF6 (p<0,05). Em relação ao uso de medicamentos nos primeiros anos de vida houve uma associação com os genes TGFα e IRF6 nas amostras de Curitiba e do Rio de Janeiro (p<0,05). Conclui-se que; (I) a prevalência de HMI é de 13.48% na população brasileira; (II) existe uma relação entre a presença de HMI com complicações que ocorrem durante a gestação (uso de medicamentos) e nos primeiros anos de vida da criança, entretanto esse fatores não influenciaram na gravidade dessa condição; (III) os genes que atuam na formação do esmalte são capazes de influenciar tanto no desenvolvimento da HMI como podem estar associados à cárie dentária e (IV) os polimorfismos localizados nos genes IRF6 e TGFα estão relacionados com o desenvolvimento da HMI. Além disso, o uso de medicamentos nos primeiros anos de vida podem potencializar o desenvolvimento da HMI. (AU)

It is a thesis composed of four studies, with the main to evaluate possible etiological factors (environmental and genetic variation) associated with the presence of MIH in the Brazilian population through (e); (objective-I); a cross-sectional observational study, with a bibliographic review of the prevalence of MIH in Brazil (objective-I); to determine of environmental factors (during in the pregany period and childhood) associated with the presence of MIH, and to evaluate the influence of these factors with the MIH severity (objective-II); associations of single nucleotide polymorphism (SNPs) presentin the genes ameloblastin (AMBN), enamelin (ENAM) and kalekrein (KLK-4) with MIH, in addition to the possible susceptibility of this genes to dental caries (objective-III); and interaction of environmetal factors and to determine the influence of genes interferon regulatory factor 6 (IRF6) and transforming growth factor alpha (TGFα) with MIH in a Brazilian (Rio de Janeiro e Curitiba) and Turkish (Istanbul) population (objective-IV). Data collections of the present study were carried out in two stages: clinical and laboratory.The results found were: (I) a high heterogeneity among the studies (Q = 52.81, p<0.01, I2 = 98) with a final prevalence of 13.48% na Brazilian population; (II) an association between intercurrences during pregnancy and child taking medications with the presence of MIH (OR = 3.55; 95% C.I = 1.35-10.57, p= 0.014; OR = 3.01; 95% C.I = 1.74- 8.42, p= 0.019, respectively), however these factors did not influence the severity of MIH (p>0.05); (III) there was an association between the variant alleles of polymorphisms rs2235091 in the KLK4 gene (p≤0.01) with the presence of MIH and the SNPs rs4694075 in AMBN and rs3796704 in ENAM presents association with dental caries (p<0.05); (IV) that the study from Rio de Janeiro showed a statistical evidence of interaction between TGFA rs1523305 and IRF6 rs642961 (p=0.03) and between genes IRF6 rs2073487 and TGFA rs2902345 (p=0.04). Significant results were found for the study from Istanbul between TGFα rs930655 and all IRF6 markers (p<0.05). Also, there was found statistical evidence for interaction of the SNPs in IRF6 and TGFα genes and medication taking from Curitiba and Rio de Janeiro studies (p<0.05). In summary; (I) the prevalence of MIH is 13.48% in the Brazilian population; (II) there is a relationship between complication that occur during pregnancy and in the child's first years of life with the presence of MIH, however these factors do not influence the severity of this condition; (III) the genes that acting in the enamel formation may influence the development of MIH and them, may be associated with dental caries; (IV) the polymorphisms located in the IRF6 and TGFα genes play a role in the development of MIH in different populations and that these genes may interacting with the medication taken in the first years of life, pontecialising the presence of MIH. (AU)

Japanese nationwide survey of hypophosphatasia reveals prominent differences in genetic and dental findings between odonto and non-odonto types.

Hypophosphatasia (HPP) is a rare and intractable metabolic bone disease caused by mutations in the ALPL gene. Here, we undertook a nationwide survey of HPP in Japan, specifically regarding the prominent genetic and dental manifestations of odonto (n = 16 cases) and other (termed "non-odonto") (n = 36 cases) types. Mean serum alkaline phosphatase (ALP) values in odonto-type patients were significantly greater than those of non-odonto-type patients (P<0.05). Autosomal dominant and autosomal recessive inheritance patterns were detected, respectively, in 89% of odonto-type and 96% of non-odonto-type patients. The ALPL "c.1559delT" mutation, associated with extremely low ALP activity, was found in approximately 70% of cases. Regarding dental manifestations, all patients classified as odonto-type showed early exfoliation of the primary teeth significantly more frequently than patients classified as non-odonto-type (100% vs. 56%; P<0.05). Tooth hypomineralisation was detected in 42% of non-odonto-type patients, but not in any odonto-type patients (0%; P<0.05). Collectively, these results suggest that genetic and dental manifestations of patients with odonto-type and non-odonto-type HPP are significantly different, and these differences should be considered during clinical treatment of patients with HPP.

Molar incisor hypomineralization: Analysis of asymmetry of lesions.

Clinically, Molar-Incisor Hypomineralization (MIH) lesions are not distributed symmetrically, and their severity varies even within the same arcade. AIM: To estimate the frequency of asymmetries in hypomineralized lesions on permanent molars and incisors of children with MIH. METHODS: Three pediatric dentists, calibrated following the diagnostic criteria of Mathu-Muju and Wright (2006) (Kappa 0.87) identified presence and severity of opacities on molars and incisors of patients with MIH. Six pairs of teeth (permanent maxillary and mandibular first molars, central and lateral incisors) were evaluated in each patient. Degree of lesion severity (0-none, 1-mild, 2-moderate, 3-severe) was recorded for each tooth. For each pair containing any affected teeth, asymmetry of presence (one tooth in the pair with lesion and the other intact), asymmetry of severity (both teeth with lesions but with different degrees of severity) or symmetry of severity (both affected teeth with the same degree of severity) were evaluated. The recorded values were entered into a database to calculate percentages, 95% confidence intervals and Chi-Square test for comparisons. RESULTS: The sample consisted of475 of the 1032 pairs of teeth evaluated in the 172 patients included in the study, mean age 11±2.2 years, and 50% female. Asymmetry was found for 67.5% (63.1 - 71.7) of the pairs of the studied teeth. There was a significant relationship between asymmetries and symmetries (p=0.038). A total 50.1% of the pairs were asymmetrical for presence of opacities. Of these, 62.2% scored severity 1 (mild). Symmetry of severity was found for 32.5% of the lesions. Among the pairs of affected teeth, the most frequently observed degrees of lesion severity were mild and moderate, with the exception of lower molars, in which 49% had severe lesions. CONCLUSIONS: In this study, MIH lesions were asymmetrical both in presence and severity for all tooth types.

Clínicamente las lesiones de Hipomineralización Molar Incisiva (HMI) no tienen una distribución simétrica variando su severidad inclusive en la misma arcada. Objetivo: Estimar la frecuencia de asimetrías en lesiones de hipomineralización en molares e incisivos permanentes de niños afectados con HMI. Métodos: Tres odontopediatras calibrados (Kappa 0,87) según los criterios de diagnóstico de Mathu-Muju y Wright (2006), registraron presencia y severidad de opacidades en molares e incisivos de pacientes con HMI. En cada paciente se evaluaron 6 pares de piezas dentarias permanentes: primeros molares, incisivos centrales y laterales de ambos maxilares. Para cada una de las piezas se registró el grado de severidad de la lesión (0-intacto, 1-leve, 2-moderado, 3-severo). Para cada par con alguna de sus piezas afectadas, se analizó si presentaba asimetría de presencia (una pieza del par con lesión y la otra intacta), asimetría de severidad (ambas piezas con lesión pero con distinto grado de severidad) o simetría (ambas piezas afectadas con el mismo grado de severidad en la lesión). Se calcularon porcentajes, I.C. del 95% y CHI2 para las comparaciones. Resultados: La muestra quedó conformada por los 475 pares de piezas dentarias que presentaron lesión entre un total de 1032pares de piezas analizadas en los 172 pacientes incluidos en el estudio (edad media 11 ± 2,2 años, 50% género femenino). El 67,5% (63,1- 71,7) de los pares de piezas dentarias estudiados presentaron relación de asimetría. La relación entre frecuencia de asimetrías y simetrías fue significativa (p= 0,038). Del 50,1% de los pares que presentó asimetrías en presencia, un 62,2% mostró grado de severidad 1(leve) en una de sus piezas. Entre los pares afectados, las lesiones leves y moderadas fueron las más observadas en todos los grupos dentarios, a excepción de los molares inferiores que revelaron un 49% de lesiones severas. Conclusiones: En este estudio las lesiones de HMI presentaron, en su mayoría, algún tipo de asimetría (de presencia o de severidad) en todos los grupos dentarios.

Hipomineralización incisivo molar y factores etiológicos ambientales. Revisión de la literatura / Molar incisor hypomineralization and etiological environmental factors. Review of the literature

La etiología de la hipomineralización incisivo-molar (HIM) aún no está totalmente definida, por lo que el objetivo del presente artículo fue hacer una revisión de la literatura de los posibles factores etiológicos asociados. Se realizó una búsqueda inicial en las bases de datos Elsevier, EBSCO, PubMed y Medline usando las siguientes palabras clave: molar incisor hypomineralisation, hypoplasia, dental enamel defects epidemiology, etiology. Se incluyeron artículos en inglés y español, estudios epidemiológicos de casos y controles de HIM, descripción del método de diagnóstico y registro, y descripción del factor asociado, publicados entre 1987 y 2018. Tomando en consideración 40 artículos que cumplían con los criterios de búsqueda. Se dividieron los factores etiológicos encontrados en tres etapas: prenatal, perinatal y posnatal. La causa exacta aún no está del todo definida, pero con base en los estudios tenemos indicios que nos podrían ayudar a prevenir este tipo de defectos. Sin embargo, son necesarios más estudios longitudinales para poder determinar la etiología exacta de esta alteración en la formación dental, mientras tanto los médicos pediatras y odontopediatras deben estar conscientes que el manejo temprano y adecuado de estas del HIM es importante. (AU)

The etiology of molar incisor hypomineralization (MIH) is not yet fully defined, therefore the objective of this article was to review the literature on the possible associated etiological factors. An initial search was performed in the Elsevier, EBSCO, PubMed and Medline databases using the following keywords: molar incisor hypomineralization, hypoplasia, dental enamel defects epidemiology, and etiology. Articles in English and Spanish were included as well as epidemiological studies of cases and controls of MIH, descriptions of the method of diagnosis and registration, and descriptions of associated factors published between 1987 and 2018. Forty articles met the search criteria. The etiological factors found were divided into three stages: prenatal, perinatal and postnatal. While the cause of MIH has yet to be fully defined, the studies available describe indications to help prevent this type of defects. Nonetheless, more longitudinal studies are necessary to determine the exact etiology of this alteration, and pediatricians and pediatric dentists should take into account the importance of early, adequate management of MIH. (AU)

Prevalence of molar incisor hypomineralisation in a group of Egyptian children using the short form: a cross-sectional study.

AIM: To estimate the prevalence of molar incisor hypomineralisation (MIH) in a group of Egyptian children aged from 8 to 12 years, seeking dental care in the Departments of Paediatric Dentistry, Faculty of Oral and Dental Medicine, Cairo and Future Universities in Egypt from December 2014 till November 2015 (1 year). METHODS: After dental screening, the MIH short charting form by Ghanim et al. (Eur Arch Paediatr Dent 16:235-46, 2015) was used which is the most recent attempt to standardise epidemiological data collection for MIH. It included 16 index teeth to be evaluated for their eruption status, clinical status and lesion extension of MIH. This was done to allow extraction of more information by expanding findings into sub-categories, which could give suggestive information about patterns of the MIH defects. Statistical analysis was performed using IBM® SPSS® and data was presented as frequency and percentages. RESULTS: 1001 children were included in the study (49.85%) males (50.14%) females. Prevalence rate calculated in the studied group was (2.3%); males (39.1%) and females (60.9%). The most prevalent clinical defect of MIH was the demarcated opacity. CONCLUSION: Prevalence of MIH in a convenience sample of Egyptian children aged 8-12 years old was (2.3%), Molars were the most prevalent teeth affected, and further studies are recommended to better understand the aetiology of the disease.

The severity and degree of hypomineralisation in teeth and its influence on oral hygiene and caries prevalence in children.

AIM: The purpose of this study was to investigate the relationship between the severity of hypomineralised teeth, plaque accumulation, hypersensitivity, associated caries risk, and oral health-related quality of life limitations of affected children. MATERIALS AND METHODS: A total of 250 children (mean age 9.0 years) presenting with at least one hypomineralised molar or incisor were included in the study. The hypersensitivity of the teeth was evaluated using the Schiff Cold Air Sensitivity Scale and the Wong-Baker Faces Scale. Furthermore, the Decayed, Missing, and Filled Teeth Index was documented, the Quigley Hein Index was obtained, and personal questioning was used to document the patients' limitations with intake of food. These data were analysed using general linear models that control influencing factors such as age and sex. RESULTS: The Quigley Hein Index increased with the severity of the hypomineralised teeth (1.64 in the unaffected, 2.77 in the moderately, and 3.63 in the severely affected teeth). Problems with intake of food were only observed in subjects with severe hypomineralisation. There was no immediate effect on dental caries. CONCLUSION: Increased severity of tooth hypomineralisation leads to increased hypersensitivity, which resulted in inadequate oral hygiene among children and limitations to their daily life.

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.

Hypomineralized second primary molars: prevalence, defect characteristics and relationship with dental caries in Melbourne preschool children.

BACKGROUND: Dental caries and enamel defects (DDE) are prevalent amongst children. The presence of DDE, especially enamel hypomineralization, may increase caries experience. The reported prevalence of hypomineralized second primary molars (HSPM) is 2.7-21.8%, although the occurrence in Australian children remains unknown. These HSPM represent a potential predictive factor for molar-incisor hypomineralization (MIH). METHODS: In total, 623 children aged 3-5 years from 30 randomly selected kindergartens participated. The HSPM were recorded using an index combining the European Academy of Paediatric Dentistry MIH Judgment Criteria and modified DDE Index. Caries was recorded using International Caries Detection and Assessment System criteria. RESULTS: In total, 144 HSPM were observed in 88 of the 623 (14.1%) children, a tooth-level prevalence of 5.8%. The prevalence of dentinal carious lesions was 13.2%, and caries prevalence (d2-6 mft > 0) was 36.4%. Cavitated carious lesions affected 30.7% of HSPM. CONCLUSIONS: The relationship between an increase in HSPM lesion extent and increasing number of HSPM per child was statistically significant. A positive association between HSPM severity and extent at tooth level existed (P < 0.05). There was a positive relationship between the extent of HSPM and carious lesion severity (P < 0.05). In this population, children with HSPM did not have overall greater caries experience.

How serious is Molar Incisor Hypomineralisation (MIH) among 8- and 9-year-old children in Bosnia-Herzegovina? A clinical study.

AIM: To determine the prevalence of MIH in 8- and 9 year-old children in the city of Kljuc, Bosnia-Herzegovina, and to describe the distribution and severity of the affected teeth. MATERIALS AND METHODS: Study design: All 8- and 9-year-olds (n=104) living in Kljuc (born 2004/2005) were invited to participate, and 103 were examined by a calibrated clinician. Written, informed consent was obtained from all participants' relatives, as well as a questionnaire designed to assess potential risk indicators. Index teeth were all permanent first molars and incisors (12 teeth). Opacities (>1mm), post eruptive breakdown (PEB), atypical restorations and previous extractions caused by MIH were registered. RESULTS: The prevalence of MIH was 11.7% (n=12), significantly higher for girls than for boys (14.6% vs. 9.7%; p<0.05). The maxillary first molars and incisors were 1.8 (p<0.02) and 2.3 (p<0.05) times more frequently affected than the mandibular ones, respectively. Seven (30%) of the affected molars had opacities, 8 (35%) had PEB and 8 (35%) atypical restorations. No molars had been extracted due to MIH. The use of penicillin due to adenoid infections in the first 5 years was associated with a higher prevalence of MIH (41.7% vs. 19.6%). CONCLUSIONS: The prevalence of MIH (11.7%) supports the data previously published from Bosnia-Herzegovina. Girls had higher prevalence of MIH than boys; first molars and incisors in the maxilla were almost twice as often affected as in the mandible. Use of penicillin in the first 5 years was associated with a higher prevalence.

The prevalence and morphological types of non-carious cervical lesions (NCCL) in a contemporary sample of people.

Non-carious cervical lesions (NCCLs) were examined in 6541 extracted human teeth and classified based on the morphology of the lesions. As a result, NCCLs were found on 38.7% of teeth (41.6% on maxillary teeth and 36.0% on mandibular teeth), and were most frequent on canines and first premolars. According to the new method of classification, the morphology of NCCLs was classified both by the surface contour (SC) and by the cross-sectional contour (CC). Three types of NCCLs appeared to be dominant. The causes of these NCCLs were discussed based on their morphologies, positions where these NCCLs were frequently found, and the results of previous studies. NCCLs with a horizontal oval SC and a round CC (Type I), which were frequent on the labial surfaces of maxillary canines and buccal surfaces of maxillary first premolars, may be associated with wear by friction and chemical degradation. NCCLs with a vertical oval SC and a round CC (Type II), which were frequent on the lingual surfaces of mandibular incisors and canines, might be mainly related to chemical degradation. NCCLs with a horizontal oval SC and a wedge shape CC (Type III), which were extensively found on the buccal surfaces of maxillary premolars, had formed most probably due to wear by friction and microstructural loss by stress. This new method can classify the morphology of NCCLs more precisely and deduce the mechanisms of the formation of NCCLs more clearly than former methods.

Hipomineralização molar-incisivo: prevalência, fatores associados e impacto na qualidade de vida relacionada à saúde bucal de escolares / Molar-incisor hypomineralization: prevalence, associated factors and impact on quality of life related to the oral health of school children

Hipomineralização molar-incisivo (HMI) corresponde ao defeito de desenvolvimento do esmalte que pode causar sensibilidade nos dentes e rápida progressão da cárie. Essas condições podem ocasionar dor e afetar a qualidade de vida. Problemas de saúde bucal impactam na qualidade de vida relacionada à saúde bucal (QVRSB). Desta forma, os objetivos deste estudo foram determinar a prevalência, fatores associados com HMI e seu impacto na QVRSB de escolares. Este foi um estudo transversal de base populacional. A amostra foi estratificada e aleatória, constituída por 1202 escolares de 8 a 10 anos de Teresina, Brasil. Os escolares foram avaliados para diagnóstico de HMI (EAPD), experiência de cárie (CPO-D), consequências clínicas de cárie não tratada (PUFA), necessidade de tratamento para o dente com HMI e má oclusão (DAI). O impacto da condição bucal na QVRSB foi avaliado por meio das versões brasileiras dos instrumentos Child Perceptions Questionnaire (B-CPQ8-10) e Parental-Caregiver Perceptions Questionnaire (B-P-CPQ) versão curta. Foi realizada análise descritiva dos dados, testes Qui-Quadrado e Mann-Whitney. Análise de Cluster foi realizada para dicotomizar a variável impacto negativo na QVRSB em alto e baixo impacto. A Regressão de Poisson com variância robusta foi realizada para análise multivariada com seus respectivos intervalos de confiança (IC 95%). Variáveis com p<0,20 foram utilizadas para modelo final e considerou-se p¿0,05 como significativo. A prevalência de HMI encontrada foi de 15,5%. Os molares inferiores foram os mais afetados pela severidade grave (60,6%). Na análise multivariada, observou-se que escolares com HMI fora associados a maior prevalência de sensibilidade dentinária (RP=1,25; IC95%:1,18-1,33) e experiência de cárie (RP=1,09; IC95%:1,03-1,15) que os escolares sem HMI. Com ele, também se demonstrou que crianças com HMI moderada estiveram associadas a maior prevalência de impacto negativo na QVRSB nos domínios sintomas orais (RP=1,20; IC95%:1,07-1,36) que crianças sem HMI. Pais de crianças com HMI grave e moderada estiveram associados a maior prevalência de relato do impacto negativo nos domínios limitação funcional (RP=1,16; IC95%:1,06-1,26) e bem-estar (RP=1,16; IC95%:1,01-1,34), respectivamente, que pais de crianças sem HMI. Assim, pode-se concluir que prevalência de HMI foi elevada. Crianças com HMI foram associados a maior prevalência de experiência de cárie dentária e sensibilidade dentinária. Crianças com HMI leve, moderada e severa foram associadas a maior prevalência de impacto negativo na QVRSB de acordo com seus pais e o autorrelato

Molar-incisor hypomineralization (MIH) corresponds to the development defect of the enamel that can cause teeth sensitivity in the teeth and rapid progression of caries. These conditions can cause pain and affect the quality of life. Oral health problems have an impact on oral health related quality of life (OHRQoL). Thus, the objectives of this study were to determine the prevalence, factors associated with MIH and their impact on the OHRQoL of schoolchildren. This was a cross-sectional population-based study. A sample was evaluated and randomized, consisting of 1202 achoolchildren from 8 to 10 years of Teresina, Brasil. The students were instructed to disgnose MIH (EAPD), caries experience (DMF-T), clinical consequences of untreadcaries (PUFA), need for treatment for the tooth with MIH and malocclusion...