Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries?

DESIGN: A prospective, randomized, split-mouth clinical study by the two previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement (GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either side of mouth. The local Ethics Committee approved this study. DATA SOURCE: Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molars and the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. STUDY SELECTION: These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. DATA ANALYSIS: Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar's test with a Bonferroni correction was used for significant differences. Cohen's kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. RESULTS: At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival probabilities for the caries-preventive effect were considerably lower in SDF + KI-treated teeth (31.01 months) than in SMART-treated teeth (35.61 months) (p < 0.001). CONCLUSION: Considering the limitation of the study, both SMART (SDF + KI + GIC) sealants and 6-monthly application of SDF + KI, provided similar and substantial levels of desensitisation on the permanent MIH molars. When used as a sealing material on non-cavitated permanent MIH molars, the clinical retention rate for SMART was 88.7%, 73.1%, and 66.6% at 1, 2, and 3 years respectively. The caries preventive effect of SMART (SDF + KI + GIC) sealants was superior to SDF + KI application in hypomineralised teeth, however, a long-term monitoring and review is essential due to the gradual decrease in retention of SMART sealants.

Dental caries prevention in pediatric patients with molar incisor hypomineralization: a scoping review.

This scoping review aims to summarize the available evidence on strategies employed in preventing caries in patients with molar incisor hypo-mineralization (MIH). MIH refers to an enamel defect involving opacities, and sometimes post-eruptive degradation due to enamel porosity; resulting in outcomes ranging from a mild atypical caries to severe coronary destruction. A systematic review was conducted for literature in PubMed, Cochrane Library, Epistemonikos and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). The search was aimed at studies published between January 2010 and February 2022. Data were independently selected and extracted. 989 studies were found from the systematic search and 8 studies met the eligibility criteria. Most studies evaluated remineralization and cariogenic risk, both of which are crucial elements in caries prevention, as well as decreased sensitivity. The included studies investigated fluoride varnish, dental sealants, giomers, casein, and Icon as preventative methods for dental caries. Several methods for preventing dental caries in paediatric patients with MIH exist, but more research is needed to determine their effectiveness and safety. Any preventive intervention should consider the etiological aspects of the disease, the risk of caries, the type and extent of lesions, hypersensitivity level and patient's age. Collaboration between patients and carers is critical for disease diagnosis and caries prevention.

Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial.

To evaluate the preventive effect of glass ionomer cement (GIC) against dental caries and posteruptive breakdown (PEB) on molars affected by molar incisor hypomineralization (MIH). In this randomized clinical trial, 77 children aged 5-9 years with at least 1 MIH-affected molar and without PEB or dentin caries lesions (n = 228) were included and randomly allocated to one of the following groups: (1) MIH-affected molars that remained unsealed and (2) MIH-affected molars that received GIC sealants. Dental caries and PEB were clinically evaluated after 6 and 12 months. Associations between dental caries and PEB with independent variables were evaluated using logistic regression analysis (p < 0.05). The MIH-affected molars allocated to the GIC sealant group were less likely to develop dental caries compared to those allocated to the unsealed group (OR = 0.23; 95% CI 0.06-0.95). Conversely, application of a GIC sealant was not associated with prevention of PEB (p = 0.313). Furthermore, MIH-affected molars presenting yellow-brown opacities were almost 5 times more likely to develop dental caries (p = 0.013) and PEB (p = 0.001) compared to those presenting white-creamy opacities. We can conclude that GIC sealants can prevent dental caries on MIH-affected molars; however, the same protective effect was not observed for PEB.

Toward Preventing Enamel Hypoplasia: Modeling Maternal and Neonatal Biomarkers of Human Calcium Homeostasis.

AIM: The aim of this study was to assess biomarkers of calcium homeostasis and tooth development, in mothers during pregnancy and their children at birth, for enamel hypoplasia (EH) in the primary maxillary central incisor teeth. METHODS: Bayesian methodology was used for secondary data analyses from a randomized, controlled trial of prenatal vitamin D3 supplementation in healthy mothers (N = 350) and a follow-up study of a subset of the children. The biomarkers were serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), total circulating 25-dihydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D). The maternal biomarkers were assayed monthly during pregnancy, and the child's biomarkers were derived from cord blood. Digital images of the child's 2 teeth were scored for EH using Enamel Defects Index criteria for each of the incisal, middle, and cervical regions for an EH extent score. RESULTS: The child EH prevalence was 41% (60/145), with most defects present in the incisal and middle tooth regions. Cord blood iPTH and 1,25(OH)2D levels were significantly associated with EH extent after controlling for maternal factors. For every 1 pg/mL increase in cord blood iPTH, the EH extent decreased by approximately 6%. For every 10 pg/mL increase in cord blood 1,25(OH)2D, the EH extent increased by almost 30% (holding all other terms constant and adjusting for subject-level heterogeneity). The relationship between maternal 25(OH)D and maternal mean iPTH varied significantly by EH extent. CONCLUSION: The results suggest possible modifiable relationships of maternal and neonatal factors of calcium homeostasis during pregnancy and at birth for EH, contributing to the frontier of knowledge regarding sound tooth development for dental caries prevention.

Longitudinal Evaluation of the Structural Integrity of Teeth Affected by Molar Incisor Hypomineralisation.

The aim of this prospective cohort study was to evaluate the risk of posteruptive breakdown and the development of caries lesions in teeth with molar incisor hypomineralisation (MIH). A total of 367 permanent incisors and first molars, affected and not affected by MIH lesions, of 45 children with MIH from Araraquara, São Paulo, Brazil, were evaluated at intervals from 6 to 12 months by assessing the severity of MIH, the presence of tooth caries lesions and the treatment needed. During the study period, all patients received preventive care. The data were analysed using Fisher's exact test and actuarial method survival analysis. Significant associations were also found in teeth between the presence of MIH and a DMFT index >0 in all periods and also between the need for treatment and the presence of MIH. The teeth affected by MIH opacities were healthy in 99% of incisors and 93% of molars at the end of the 12-month period. Due to the high likelihood of maintaining the tooth structure in opacities, the complete or premature removal of the affected area is not justified.

Case report of a novel interim approach to prevent early posteruptive enamel breakdown of molar-incisor hypomineralization-affected molars.

BACKGROUND AND OVERVIEW: Severely molar-incisor hypomineralization (MIH)-affected teeth are prone to develop early posteruptive enamel breakdown (PEB) and caries. A novel conservative interim approach for the prevention of this complication is presented. CASE DESCRIPTION: A 6-year-old boy with strong hypersensitivity and extensive brown opacities in the partially erupted mandibular permanent first molars (PFMs) was diagnosed with MIH. Constant hygiene and dietary counseling were followed by the application of luted orthodontic bands and glass ionomer sealants to protect PFMs from caries and PEB until the complete eruption of the teeth. After 36 months, the PFMs were completely erupted, with no caries and PEB, and the cooperation of the child increased. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Temporary strategies are useful to preserve MIH-affected PFMs. With the methodology described, the hypersensitivity decreased and the patient reached a good degree of cooperation, making possible definitive rehabilitative considerations.

Factors associated with the development of dental defects acquired in the extrauterine environment.

This study aimed to analyze the association of sociodemographic, child health, healthcare service, and access indicators with developmental defects of enamel (DDE) acquired outside the uterus, based on gestational factors. A cohort of births was carried out, and 982 children aged 12 to 30 months were examined. A total of 1,500 women were followed up as of the 5th month of gestation, and the child's gestational age was evaluated at follow-up. The clinical examination was performed as recommended by the World Health Organization, and defects were classified using the modified DDE index. Six models were considered: presence of DDE (Model 1) or opacities (Model 4), number of teeth with DDE (Model 2) or opacities (Model 5), and incidence rate of DDE (Model 3) or opacities (Model 6). Associations were estimated by relative risk (RR) in Poisson regression models. In the adjusted analysis, the mother's lowest education level was associated with the highest occurrence of DDE in Models 1 (RR = 26.43; p = 0.002), 2 (RR = 9.70; p = 0.009), and 3 (RR = 5.63; p = 0.047). Breastfeeding for over 12 months (RR = 0.45; p = 0.030) and recent use of anti-infection drugs (RR = 0.20; p = 0.039) had a protective effect on DDE (Model 1). The factors associated with the highest incidence of opacities were not having health insurance (RR = 2.00; p = 0.043) (Model 5), and belonging to a family of poor social class (RR = 4.67; p = 0.007) (Model 6). Children in a situation of socioeconomic vulnerability have a higher risk of presenting extrauterine DDE. Breastfeeding was a protection factor for DDE development.

A Case Report of Esthetic and Functional Correction of Maxillary Protrusion Using a Prosthodontics-Centered Multidisciplinary Approach.

Maxillary protrusion usually requires orthodontic therapy and orthognathic surgery. However, for some exceptional cases, a prosthodontics-centered multidisciplinary approach could serve as an alternative. This case report describes a 53-year-old patient with protrusive and proclined maxillary incisors, compensatory eruption of mandibular incisors, color and morphologic abnormalities of anterior teeth lip incompetence, and gummy smile. Final esthetic improvement was achieved in this patient by means of a multidisciplinary approach involving endodontic and periodontal procedures before prosthodontic treatment. Accurate diagnosis, comprehensive communication, a sophisticated treatment plan, and state-of-the-art therapeutic processes are all important factors for achieving a predictable esthetic result.

The role of early dietary habits in dental caries development.

Early Childhood Caries (ECC) is a serious dental condition that occurs during the first three years of life and is associated with the early intake of sugary foods, drinks, or snacks. There is now evidence that early malnutrition episodes could lead to delay in the eruption of primary teeth and possibly to increased caries prevalence. Significant correlations are present between the intakes of carbohydrates, proteins, and fats during infancy and several years later in life. Infants' dietary intake is also significantly correlated with the dietary intake of their mothers. Supplementing milk with vitamins during the first several years of life leads to reduction in the prevalence of linear enamel hypoplasia, a condition that may be associated with future development of dental caries. There are equivocal findings concerning the value of using dietary habits to predict caries incidence during the first three years of life. There is a need for development of educational, nutritional, and prevention programs targeting mothers and infants and for research on effective methods to prevent Early Childhood Caries.

[An enamel disorder in two siblings]. / Een glazuurafwijking bij twee zusjes.

Two sisters exhibit a similar enamel disorder. It is a hereditary developmental disorder, diagnosed as amelogenesis imperfecta. In this article the various types of amelogenesis imperfecta are discussed and the clinical consequences, genetic aspects, and basic guidelines for treatment are addressed.

[Comparison of the prevalence of molar incisor hypomineralization among children with different health care coverage in the cities of Buenos Aires (Argentina) and Montevideo (Uruguay)]. / Comparación de la prevalencia de hipomineralización molar incisiva en niños con diferente cobertura asistencial en las ciudades de Buenos Aires (Argentina) y Montevideo (Uruguay).

The aim of this study was to compare the prevalence of molar incisor hypomineralization (MIH) among children with different health care coverage in Buenos Aires and Montevideo. An observational, cross-sectional and descriptive study was designed, considering children born from 1993-2003 who were seen in the Chairs of Comprehensive Children's Dentistry (Universidad de Buenos Aires) and of Pediatric Dentistry (Universidad de la República) and at five private dental offices between April and December 2010. Two groups were defined: A (Buenos Aires; n=1,090) and B (Montevideo; n=626). The clinical diagnosis was carried out with calibrated examiners (Kappa: 0.94) using the Mathu-Muju and Wright criteria. The prevalence of MIH was found to be 16.1% in A and 12.3% in B (p=0.03), with statistically significant differences between the public and private care sectors in both groups (A p=0.0008; B p=0.0004) and a positive correlation between MIH and year of birth (A p=0.001; B p=0.005). The results show that MIH is an emerging pathology and that MIH prevalence is related to year of birth and access to health care.

Prenatal vitamin D and dental caries in infants.

OBJECTIVES: Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life. METHODS: This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers' 25OHD levels. A P value ≤ .05 was considered significant. RESULTS: Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC. CONCLUSIONS: This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.

Factors associated with the development of dental defects acquired in the extrauterine environment

Abstract This study aimed to analyze the association of sociodemographic, child health, healthcare service, and access indicators with developmental defects of enamel (DDE) acquired outside the uterus, based on gestational factors. A cohort of births was carried out, and 982 children aged 12 to 30 months were examined. A total of 1,500 women were followed up as of the 5th month of gestation, and the child's gestational age was evaluated at follow-up. The clinical examination was performed as recommended by the World Health Organization, and defects were classified using the modified DDE index. Six models were considered: presence of DDE (Model 1) or opacities (Model 4), number of teeth with DDE (Model 2) or opacities (Model 5), and incidence rate of DDE (Model 3) or opacities (Model 6). Associations were estimated by relative risk (RR) in Poisson regression models. In the adjusted analysis, the mother's lowest education level was associated with the highest occurrence of DDE in Models 1 (RR = 26.43; p = 0.002), 2 (RR = 9.70; p = 0.009), and 3 (RR = 5.63; p = 0.047). Breastfeeding for over 12 months (RR = 0.45; p = 0.030) and recent use of anti-infection drugs (RR = 0.20; p = 0.039) had a protective effect on DDE (Model 1). The factors associated with the highest incidence of opacities were not having health insurance (RR = 2.00; p = 0.043) (Model 5), and belonging to a family of poor social class (RR = 4.67; p = 0.007) (Model 6). Children in a situation of socioeconomic vulnerability have a higher risk of presenting extrauterine DDE. Breastfeeding was a protection factor for DDE development.

Comparación de la prevalencia de hipomineralización molar incisiva en niños con diferente cobertura asistencial en las ciudades de Buenos Aires (Argentina) y Montevideo (Uruguay) / Comparison of the prevalence of molar incisor hypomineralization among children with different health care coverage in the cities of Buenos Aires (Argentina) and Montevideo (Uruguay)

El objetivo fue comparar la frecuencia de la hipomineralización molar incisiva (HMI) entre niños con diferente cobertura de salud en Buenos Aires y Montevideo. Se diseñó un estudio transversal, observacional y descriptivo con los nacidos entre 1993-2003, asististidos en las Cátedras de Odontología Integral Niños (Universidad de Buenos Aires) y de Odontopediatría (Universidad de la República) y en cinco clínicas privadas, entre abril y diciembre 2010. Se conformaron dos grupos: A (Buenos Aires; n=1.090) y B (Montevideo; n=626). El diagnóstico clínico fue realizado por examinadores calibrados (Kappa: 0,94) con los criterios de Mathu-Muju y Wright. Los resultados mostraron una prevalencia de HMI en A del 16,1% y en B del 12,3% (p=0,03), con diferencias significativas entre los sectores público y privado en ambos grupos (A p=0,0008; B p=0,0004) y una correlación positiva entre la HMI y el año de nacimiento (A p=0,001; B p=0,005) Los resultados permiten concluir que la HMI es una patología emergente y su prevalencia se relaciona al año de nacimiento y al acceso al cuidado de salud.

The aim of this study was to compare the prevalence of molar incisor hypomineralization (MIH) among children with different health care coverage in Buenos Aires and Montevideo. An observational, cross-sectional and descriptive study was designed, considering children born from 1993-2003 who were seen in the Chairs of Comprehensive Children's Dentistry (Universidad de Buenos Aires) and of Pediatric Dentistry (Universidad de la República) and at five private dental offices between April and December 2010. Two groups were defined: A (Buenos Aires; n=1,090) and B (Montevideo; n=626). The clinical diagnosis was carried out with calibrated examiners (Kappa: 0.94) using the Mathu-Muju and Wright criteria. The prevalence of MIH was found to be 16.1% in A and 12.3% in B (p=0.03), with statistically significant differences between the public and private care sectors in both groups (A p=0.0008; B p=0.0004) and a positive correlation between MIH and year of birth (A p=0.001; B p=0.005). The results show that MIH is an emerging pathology and that MIH prevalence is related to year of birth and access to health care.

Clinical studies on molar-incisor-hypomineralisation part 2: development of a severity index.

AIM: This was to examine the records of 182 children (aged 6-14 years) with molar-incisor-hypomineralisation (MIH) or molar hypomineralisation (MH) in order to develop and examine a Hypomineralisation Severity Index for first permanent molars (FPMs). STUDY DESIGN: Records of 429 FPMs in these children were examined and scored for eruption status, extent of hypomineralisation, sensitivity, number of restorative treatments; summed scores were converted to an index for each dentition (possible range: 1.25-7.00). Indices were examined regarding medical conditions occurring singly or in combinations in parentally-recalled children's histories to age 3 years; mean indices were compared for dentitions with these conditions/combinations. RESULTS: The proportion of FPMs receiving no/preventive treatment was higher in dentitions with MH than with MIH (56% vs. 41%); restorative treatment for FPMs was more frequent in dentitions with MIH than with MH (45% vs. 29%). Dentitions with MIH had higher severity indices than those with MH (MIH: index range: 3.25-5.25: 43%; MIH: index range: 1.25-2.00: 61%). Mean severity indices clearly had a higher trend in dentitions of children with certain condition combinations than for those without. Ten condition combinations each contained 3 to 5 medical conditions; 11/12 condition combinations included fevers; 9/12 included chicken pox; 9/12 included perinatal conditions, 6/12 included antibiotic use. CONCLUSIONS: A preliminary Hypomineralisation Severity Index developed for dentitions with hypomineralised first permanent molars in children has shown that MIH and MH form part of an MIH spectrum, where MIH is a more severe form of the condition than MH. The index has indicated associations between hypomineralisation of these molars and combinations of medical conditions, particularly implicating fevers, chicken pox, perinatal conditions and antibiotic use. Further clinical studies are indicated to validate the proposed index and confirm its prognostic value in treatment planning.

Decline in enamel hypoplasia in relation to fluoridation in Australians.

Enamel hypoplasias are thought to represent calcification disruption indicative of metabolic stress during development. Hypoplasias of permanent maxillary central incisors and mandibular canines have undergone a notable reduction in frequency between Euro-Australian twins born around 1965 and those born ca. 1990. Even when scored very liberally these linear defects are 3.1-4.6 times as prevalent in the earlier Australians, and the discrepancy is proportionately greater among strictly scored defects. Likely correlates of this secular trend logically include reduced childhood fevers and clinical intervention to reduce circum-natal stresses acting on cotwins. However, fluoridation of metropolitan water has emerged as the statistically strongest hypoplasia-preventing factor.