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

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

Defining the Prevalence of Molar Incisor Hypomineralization in Brazil

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

Aesthetic perceptions and social judgments about different enamel opacities

Abstract This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

The functional EGF+61 polymorphism and nonsyndromic oral clefts susceptibility in a Brazilian population

AbstractNonsyndromic oral clefts are considered a problem of public health in Brazil, presenting a multifactorial etiology that involves genetic and environmental components, such as maternal alcohol consumption. Several candidate genes have been investigated to identify some association with nonsyndromic clefts risk. The epidermal growth factor (EGF) gene is implicated in the normal craniofacial development and its functional +61 A>G polymorphism has been related to cancer susceptibility. It has been suggested that cancer and oral clefts may share the same molecular pathways.Objective Our goal was to evaluate the association between the EGF+61 A>G polymorphism and nonsyndromic oral clefts susceptibility.Material and Methods The case-control study included 218 cleft cases and 253 controls from Brazil. The control group was comprised of individuals without congenital malformations, dental anomalies and family history of clefts. The cleft phenotypes and subphenotypes were determined based on clinical examination. Genomic DNA was extracted from oral mucosa cells obtained by mouthwash. The EGF+61 A>G polymorphism genotype was determined by polymerase chain reaction-restriction fragment length polymorphism.Results We noticed the association between maternal alcohol consumption during pregnancy and cleft occurrence. The A allele and AA genotype were over-represented in cleft cases compared with control group when we considered the bilateral cleft lip with or without cleft palate (CL±P) cases, cleft cases with tooth agenesis and cleft cases presenting family history of cleft, but the differences were not statistically significant. Contradictorily, the G allele was higher in cleft palate only (CP) cases than in control group, showing a borderline p value. Comparing the different cleft phenotypes, we observed statistical differences between CP and CL±P cases. Our data suggest the EGF+61 A>G polymorphism was not related with nonsyndromic oral clefts susceptibility in a Brazilian population, but supported the different genetic background between CL±P and CP. Moreover, we confirmed the potential effect of maternal alcohol intake on cleft risk in our population.

Aesthetic solution to fluorosis in a child / Solução estética para a fluorose em criança

Dental fluorosis is a defect of enamel formation caused by chronic ingestion of fluoride from different sources during tooth development, which results in interference in proper mineralization. Clinically the tooth enamel may present as white striae along the lines of enamel, opaque white spot and in more severe cases as brown spots. Diagnosis is based on clinical characteristics associated with a history of exposure to fluoride. The aim of this report is to present a treatment in a child with severe aesthetic compromising in anterior maxillary permanent teeth caused by fluorosis. The treatment was based on a combination of three techniques in order to be minimally invasive, enhance aesthetics and preserving the dental structure

Fluorose dental é um defeito na formação do esmalte causado pela ingestão crônica de flúor de diferentes origens durante o desenvolvimento dentário, o que resulta em uma interferência na mineralização adequada. Clinicamente, o esmalte dentário pode assumir uma tonalidade esbranquiçada ou exibir pequenas manchas ou linhas brancas e, nos casos mais severos, manchas amarronzadas. O diagnóstico é baseado em características clínicas associadas com a história de exposição ao flúor. O foco deste estudo é mostrar o tratamento em uma criança com grande comprometimento estético em dentes permanentes anteriores superiores acometidos por fluorose. O tratamento baseou-se numa combinação de três técnicas, a fim de ser minimamente invasiva, melhorar a estética e preservar a estrutura dentária

Granuloma periapical extenso en la región de molar primario: asociación con agenesia del premolar sucesor / Extensive periapical granuloma in the primary molar region: association with agenesis of the succesor premolar

El objetivo de este trabajo fue explorar la posible asociación entre un granuloma periapical extenso en la región de molares primarios y la agenesia del premolar sucedáneo. Una niña blanca de 10 años con una tumefacción indolora en la región mandibular derecha quien al examen radiográfico reveló presencia de una lesión radiolúcida, única, bien definida y amplia, con un diámetro de aproximadamente 15 mm, en íntima asociación con la región periapical del segundo molar inferior primario derecho con destrucción de la corona clínica por caries, también se observa la ausencia del segundo premolar inferior sucesor derecho. Se procedió a la eliminación total de la lesión intraósea y el diente asociado, el tejido extirpado fue diagnosticado histopatológicamente como un Granuloma Periapical. Después de 3 meses de seguimiento la paciente mostró una buena cicatrización postquirúrgica del defecto óseo por la eliminación de la lesión inflamatoria. Este caso clínico concluye que la etiopatogenia de la agenesia dentaria no es del todo conocida y sugiere que otros factores no genéticos, como grandes lesiones periapicales, podrían influir a nivel local en las primeras etapas de la odontogénesis y llevar a cabo la formación del segundo premolar inferior, aunque se necesitan más estudios sobre el tema

The aim of this study was to explore the possible association between a large periapical granuloma in the primary molar region and agenesia of the successor premolar. A 10 years old white girl with a painless swelling in the right mandibular region in the radiographic examination revealed the presence of a radiolucent lesion, single, well defined and comprehensive, with a diameter of about 15 mm, in close association with the apical region of the second right primary molar widely decayed, also noting the absence of the second premolar successor. Proceeded to the total elimination of the intraosseous lesion and the associated tooth, the removed tissue was histopathologically diagnosed as a periapical granuloma. Three-month follow-up after treatment the patient showed good postoperative bone defect healing by eliminating the inflammatory lesion. This clinical report concludes that the etiopathogenesis of dental agenesis is not entirely known and suggests that other non-genetic factors, such as large periapical lesions, could influence locally in the early stages of odontogenesis and compromise the formation of the lower second premolar, although more research is needed on the subject

Abordagem multidisciplinar no tratamento de um paciente pediátrico com traumatismo dentário / Multidisciplinary approach to treat a pediatric patient with dental trauma

Objetivou-se relatar uma abordagem multidisciplinar na reabilitação funcional e estética após traumatismo dentário em um pacientepediátrico. Um paciente do sexo masculino, 9 anos de idade, apresentou-se com fratura coronária complexa do elemento 21 e impactação do elemento 11 devido a presença de odontoma. No elemento 11, após a remoção do odontoma foi observado a sua erupção espontânea restabelecendo sua estética e função. No elemento 21, o paciente recebeu um tratamento multidisciplinar, no qual realizou-se: aumento de coroa clínica, tracionamento ortodôntico, tratamento endodôntico, cimentação de retentor intrarradicular e restauração estética. As abordagens multidisciplinares são componentes importantes para o sucesso da reabilitação funcional e estética de complexas fraturas coronárias.

The objective was to report a multidisciplinary approach in the functional and esthetic rehabilitation after dental trauma in apediatric patient. A male patient, 9 years old, presented with a complex crown fracture of the element 21 and 11 impaction of the element due to the presence of odontoma. In element 11, after the removal of odontoma was found at his spontaneous eruption restoring its function and aesthetics. In element 21, the patient received a multidisciplinary treatment, following: an increase in clinical crown, orthodontic traction, endodontic treatment, cement retainer intraradicular and aesthetic restoration. Multidisciplinary approaches are important components for successful rehabilitation of complex functional and aesthetic crown fractures.

A adesão a medidas preventivas em saúde bucal em crianças e adolescentes portadores de fissura labiopalatina / Adherence to preventive oral health measures in children and adolescents with cleft lip and palate

O objetivo deste estudo foi o de avaliar a adesão a medidas preventivas em saúde bucal de crianças e adolescentes portadores de fissuras labiopalatinas. A amostra foi composta por crianças e adolescentes com idade entre 5 e 18 anos, portadores de fissura labiopalatina isolada, em tratamento em um hospital de referência para reabilitação de malformações craniofaciais no Rio de Janeiro, entre os meses de agosto e novembro de 2009. O responsável/paciente respondeu a um questionário composto por dados sócio-demográficos e hábitos de higiene bucal e dieta. Através do exame clínico e dos prontuários médico/odontológico, foi possível identificar o tipo de fissura oral: fissura de lábio isolada (FL); fissura de lábio associada ao palato (FLP) e fissura de palato isolada (FP). Cento e oito questionários foram respondidos, e a amostra final foi composta por 100 questionários correspondentes a 53 crianças e 47 adolescentes com a maior prevalência do gênero masculino (55,0%) e indivíduos caucasianos (46%). O tipo de fissura oral mais frequente foi a FLP (63%,0), seguida da fl(19,0%) e da FP (18,0%). A maioria dos participantes do estudo relatou que realizava a escovação dos dentes três vezes ao dia, não fazia uso do fio dental e do enxaguatório bucal. A ingestão de doces entre as refeições foi mais relatada pelas crianças (66,0%), sem diferença estatística entre crianças e adolescentes (p=0,08). Observou-se que 15 (27,3%) meninos e 19 (42,2%) meninas relataram usar fio dental, sem diferença entre os gêneros (p=0,11). De acordo com os resultados observados, a adesão de medidas preventivas em saúde bucal na população foi considerada parcial. Embora a maioria dos participantes realizasse a escovação dentária três vezes ao dia, o uso do fio dental foi negligenciado, e a ingestão de doces entre as refeições foi relatada por um grande número de participantes do estudo.

The aim of this study was to assess the adherence to preventive oral health measures of children and adolescents with cleft lip and palate. The sample was composed of children and adolescents aged varied 5 to 18 years, with isolated cleft lip and palate in treatment at a referral hospital for rehabilitation of craniofacial malformations in Rio de Janeiro, between August and November 2009. The guardian/patient answered a questionnaire comprising socio-demographic data and oral hygiene habits and diet. Through clinical records and medical/dental care, it was possible to identify the type of oral clefts: cleft lip (CL), cleft lip with cleft palate (CLP) and cleft palate alone (CP). One hundred and eight questionnaires were completed and the final sample consisted of 100 questionnaires corresponding to 53 children and 47 adolescents with a higher prevalence of males (55%) and caucasians (46%). The most common type of oral cleft was CLP (63.0%), followed by CL (19.0%) and CP (18.0%). Almost all participants reported that they brushed their teeth three times a day; on the other hand, they did not use dental floss and mouthwash. The intake of sweets between meals was reported more frequently by children (66.0%), no statistical diff erence between children and adolescents (p=0.08) was observed. It was observed that 15 (27.3%) boys and 19 (42.2%) girls reported using dental floss, there was no diff erence between genders (p=0.11). According to the results, adherence to preventive measures in oral health in this population was considered partial. Although most participants to perform the tooth brushing three time a day, flossing has been neglected and eating sweets between meals was reported by a large number of study participants.

Supernumerary teeth vary depending on gender

The presence of supernumerary teeth (ST) is a dental developmental anomaly of patterning and morphogenesis. Its variability of morphology, location and developmental timing can shed light on its etiology. In this work we report ST patterns. Orthopantomograms of 1,166 pediatric subjects were examined and the morphology, location and timing of the formation of ST were determined. The frequency of supernumerary teeth in the studied population was 2.3 percent (n = 27). Twenty-five subjects presented one ST. Maxilla midline was the most commonly affected region (nine cases). We noted high incidence of conical morphology in the midline region. Only teeth with tuberculate morphology presented delayed formation. ST in the midline region occurred more often in males whereas ST in the incisor region were more common in females. In conclusion, ST patterns vary depending on gender.

Alterações do desenvolvimento dentário em pacientes portadores de fissuras de lábio e/ou palato: revisão de literatura / Dental abnormalities in patients with cleft lip and palate: literature review

A fissura labiopalatal é uma das anomalias congênitas mais frequentes no ser humano, capaz de comprometer o lábio e/ou palato de forma completa ou incompleta. Sua etiologia não é totalmente conhecida, no entanto, é considerada multifatorial, com envolvimento de fatores genéticos e ambientais. Inúmeras alterações sistêmicas decorrentes dessa malformação são encontradas nestes indivíduos. Além disso, a fala, a estética e a posição dos dentes normalmente estão afetados. Sabe-se que uma alta prevalência de anomalias dentárias, como, por exemplo, agenesias, microdontias, dentes supranumerários e hipoplasias são achados comuns na cavidade bucal destes indivíduos. O objetivo deste trabalho é apresentar uma revisão de literatura sobre as anomalias dentárias mais frequentemente observadas em pacientes portadores de fissuras labiopalatais e destacar a importância do diagnóstico precoce realizado pelo cirurgião-dentista no decorrer do tratamento desses pacientes.

Cleft lip and palate is one of the most common congenital anomalies in humans, affecting the lip and/or palate with a cleft completeness or incompleteness. Its etiology is unknown, however, is considered multifactorial, with genetic and environmental components. Many systemic abnormalities arising from this malformation are found in these individuals. Also, speech, esthetics and the position of teeth are usually affected. It is known that a high prevalence of dental anomalies such as agenesis, supernumerary tooth and hypoplasia are common findings in the oral cavity of these individuals. The aim of this article is to present a review of the literature considering the higher prevalence of dental anomalies in patients with oral clefts and highlighted of early diagnosis performed by the dentist during the dental treatment of these patients.

Proteção pulpar direta com agregado trióxido mineral (MTA) em molar decíduo com agenesia do sucessor permanente / Direct pulp protection with mineral trioxide aggregate (MTA) in a primary molar with successor permanent agenesis

A manutenção do elemento decíduo na arcada tem fundamental importância no estabelecimento de uma oclusão normal, principalmente em casos de agenesia dental. A proteção pulpar direta é um tratamento conservador que visa à manutenção da vitalidade pulpar e possibilita a permanência do elemento dental na arcada. Um material recentemente utilizado é o Agregado Trióxido Mineral, devido às suas propriedades favoráveis, como atividade antimicrobiana e alta biocompatibilidade. Desta forma, o presente trabalho objetivou relatar um caso clínico de proteção pulpar direta com Agregado Trióxido Mineral em um molar decíduo com agenesia do sucessor permanente. Após o procedimento de proteção pulpar direta, as respostas teciduais foram acompanhadas clínica e radiograficamente durante dois anos e dois meses. Não foi observada a formação de tecido dentário, devido à avançada idade dentária. Entretanto, o Agregado Trióxido Mineral funcionou como uma barreira física capaz de vedar o tecido pulpar, mantendo-se a vitalidade pulpar, com ausência de sintomatologia dolorosa; demonstrou-se, assim, ser um material efciente para o tratamento conservador pulpar direto de dentes decíduos, mesmo com idade dental avançada e agenesia do elemento sucessor.

The preservation of primary teeth in arch has fundamental importance on establishing of normal occlusion, mainly in cases of teeth agenesis. Direct pulp protection is a conservator treatment which main objective is the maintenance of pulp vitality and teeth function in arch. Mineral Trioxide Aggregate is a material used due to favorable properties as antimicrobial activity and high biocompatibility. Therefore, the objective of the present work was to relate a case report of direct pulp protection with Mineral Trioxide Aggregate in a primary molar with successor permanent agenesis. After direct pulp protection procedures, tissue responses were clinically and radiographically assessed during two years and two months.It was not observed dental tissue formation, probably due to advanced dental age. Mineral Trioxide Aggregate act as physical barrier, isolating pulp tissue, maintaining teeth vitality and absence of pain, thus demonstrating effciency, even in teeth with advanced age mainly in cases of tooth agenesis.

Estudo da relação de genes e agenesia dentária em uma população brasileira / The relationship between dental agenesis and genes in Brazilian population

O principal fator etiológico da agenesia dentária é a hereditariedade. Os genes MSX1 e PAX9 estão comprovadamente associados com o ligodontia. O objetivo deste trabalho foi averiguar a existência de associação desses genes com hipodontia em uma população brasileira. Esta pesquisa foi desenvolvida na Faculdade de Odontologia de uma instituição pública de ensino superior, em duas etapas. Na primeira parte, foram avaliadas 1034 radiografias panorâmicas, de crianças de 6 a 12 anos de ambos os gêneros, com a finalidade de se identificar a ocorrência de anodontias. Das radiografias analisadas, 519 eram de crianças do gênero masculino e 515 crianças do gênero feminino, sendo encontrados 39 casos de agenesia dentária, perfazendo uma prevalência de 3,77%. A esses 39 casos de agenesia dentária, para a segunda parte deste estudo, foram acrescentados mais 116 probandos provenientes de clínicas odontológicas privadas das cidades do Rio de Janeiro totalizando 155 pacientes com ausência congênita de, pelo menos, 1 dente permanente, a exceção dos terceiros molarares. A coleta do material biológico foi realizada de acordo com protocolo padrão e amplificado por reações em cadeia de polimerase (PCR). Através de seqüenciamento direto das regiões codificantes, não foram encontradas mutações potencialmente patogênicas nos genes MSX1 e PAX9. Esses resultados sugerem que outros genes candidatos devem desempenhar um papel na hipodontia em seres humanos.

Odontodisplasia regional: revisão da literatura e relato de caso clínico / Regional odontodysplasia: literature review and clinical case report

Os autores descrevem sobre a odontodisplasia regional, com uma revisão da literatura e apresentação de um caso clínico de uma criança de cor branca, sexo masculino com 4 anos de idade com envolvimento do 1º molar decíduo superior esquerdo