Inheritance pattern of molar-incisor hypomineralization

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth

The purpose of this study was to evaluate the 12-month clinical performance of glass ionomer restorations in teeth with MIH. First permanent molars affected by MIH (48) were restored with glass ionomer cement (GIC) and evaluated at baseline, at 6 and at 12 months, by assessing tooth enamel breakdown, GIC breakdown and caries lesion associations. The data were analyzed using the chi-square test and actuarial survival analysis. The likelihood of a restored tooth remaining unchanged at the end of 12 months was 78%. No statistically significant difference was observed in the association between increased MIH severity and caries at baseline (p > 0.05) for a 6-month period, or between increased MIH severity and previous unsatisfactory treatment at baseline (p > 0.05) for both a 6- and 12-month period. A statistically significant difference was observed in the association between increased MIH severity and extension of the restoration, involving 2 or more surfaces (p < 0.05) at both periods, and between increased MIH severity and caries at baseline (p < 0.05) at a 12-month period. Because the likelihood of maintaining the tooth structures with GIC restorations is high, invasive treatment should be postponed until the child is sufficiently mature to cooperate with the treatment, mainly of teeth affected on just one face.

Aesthetic management of molar-incisor hypomineralization

Introduction: Molar-incisor hypomineralization (MIH) has been challenging for clinical practice. The term refers to an enamel defect that affects permanent molars and often permanent incisors. This defect may result in high sensibility, coronal destruction of the molars, aesthetic problem when incisors are affected, which can jeopardize the child`s emotional and psychological development. Objective: The aim of this paper is to report two cases in which a conservative approach was adopted using new technologies for direct restorative treatment of incisor with MIH opacities. Case report: Patients aged 11 and 12 years-old attended to the clinics of the School of Dentistry (Sao Paulo State University - Unesp) complaining about the appearance of incisors due to the presence of opacities on the labial surface. The cases were diagnosed as MIH, presenting enamel defects on the permanent molars and incisors. Direct restorations were carried out with minimal removal of the opacities using CVD diamond tip (CVDentus, São José dos Campos, São Paulo, Brazil) coupled to an ultrasonic device (CVDentus, São José dos Campos, São Paulo, Brazil) and direct restorations with composite resin. The result of the restorative treatment was satisfactory in both cases, with children showing immediate satisfaction. Conclusion: The incisors affected by MIH should be treated to improve the child`s self-esteem and avoid negative effects on their psychology development. The aesthetic treatment of the incisors should be conservative, since the replacements of restorations are needed throughout life.

Manifestation of molar-incisor hypomineralisation in twins: clinical case reports / Manifestação da hipomineralização molar-incisivo em gemelares: relatos de casos clínicos

A Hipomineralização molar-incisivo é um defeito qualitativo do tecido dental, de origem sistêmica, que afeta um ou mais primeiros molares permanentes e, por vezes, os incisivos permanentes. Ainda não há dados conclusivos sobre a etiologia desta hipomineralização, no entanto, os fatores sistêmicos, como doenças respiratórias e complicações prénatais e perinatais são considerados como possíveis causas. O objetivo deste estudo é apresentar três casos clínicos de crianças gemelares, sendo um casal de gêmeos monozigóticos, e dois gêmeos dizigóticos com a alteração de hipomineralização molar-incisivo, além de mostrar evidências de sua manifestação, bem como as características clínicas e os fatores etiológicos envolvidos. Os achados clínicos envolvendo gêmeos mostram que ameloblastos são especificamente afetados em sua fase de desenvolvimento, que inclui uma série de fatores, como complicações pré-natais e perinatais, porém não decisivos no desenvolvimento da alteração e sugere ainda uma possível susceptibilidade genética para a esta doença. São necessários estudos observacionais prospectivos utilizando uma amostra da população, contendo dados sobre os últimos três meses de gestação até a erupção dos dentes permanentes para confirmar as possíveis relações de causa-efeito.

Molar-incisor hypomineralisation is a qualitative defect of dental tissue of systemic origin affecting one or more permanent first molars and sometimes the permanent incisors as well. There are still no conclusive data on the aetiology of this hypomineralisation, however, systemic factors such as respiratory diseases and prenatal and perinatal complications are regarded as possible causes. The objective is to present three clinical cases of twins, one Monozygotic and two Dizygotic Twins with molar-incisor hypomineralisation, showing evidence of its manifestation as well as clinical the characteristics and aetiological factors involved. The clinical findings involving twins suggest that ameloblasts are specifically affected in their developmental phase, which includes a number of factors. Although prenatal and perinatal complications are not decisive in the development of molar-incisor hypomineralization, it is suggested a possible genetic susceptibility to the disease. Prospective observational studies using a population sample containing data on the last three months of gestation to the eruption of permanent teeth are needed to confirm the causeeffect relationships.

M.I.H. (Hipomineralização Molar Incisivo) - Um dos defeitos de esmalte mais desafiadores na Odontopediatria / MIH (Molar-Incisor Hypomineralization) - One of the enamel defects most challenging in Pediatric Dentistry

Um dos grandes desafios atuais da Odontologia é o tratamento dos pacientes com o defeito de esmalte conhecido como Hipomineralização Molar-Incisivo (HMI), que está intimamente relacionado com o desenvolvimento de lesão cariosa. Os fatores etiológicos envolvidos ainda não estão totalmente elucidados. Alterações sistêmicas que sensibilizam os ameloblastos no período entre o último trimestre gestacional e os três primeiros anos de vida podem estar associadas ao defeito do esmalte. Contudo, existe uma grande questão na literatura com relação a um possível padrão genético de transmissibilidade, pois a HMI pode se tratar de uma condição autossômica recessiva ou até mesmo, uma forma desconhecida de amelogênese imperfeita. Diante da complexidade de variáveis que envolvem a referida condição, o intuito do presente artigo é relatar as características da doença no sentido de contribuir para o seu diagnóstico, por meio da apresentação de dois casos acompanhados na Clínica de Pós-Graduação da Faculdade de Odontologia de Araraquara-Unesp.

One of the main challenges of Dentistry is the treatment of patients with a enamel defects known as Molar-Incisor Hypomineralization (MIH), which is closely related to the developmentof caries lesions. The etiological factors involved are not yet fully elucidated.Systemic conditions that sensitize the ameloblasts in the period between the last trimester of pregnancy and the first three years of life may be associated with enamel defects. However, there is a big issue in the literature regarding a possible genetic pattern of transmission, because the HMI can deal with an autosomal recessive condition or evenan unknown amelogenesis imperfecta form. Given the complexity of variables involving this condition, the aim of this paper is to report the disease characteristics in order to contribute to the diagnosis, by presenting two cases followed at the Graduate Clinic atAraraquara School of Dentistry -UNESP.

Hipomineralização molar-inciso: avaliação longitudinal em crianças de 6 a 9 anos / Molar-incisor hypomineralization: longitudinal evaluation in children 6 to 9 years

Os objetivos deste estudo foram: observar a evolução clínica dos pacientes com HMI, para estabelecer a relação entre a sua severidade com fatores socioeconômicos, índice CPO-D e a presença de DDE, avaliar a evolução clínica do dente afetado por HMI, para estabelecer a relação com a presença de cárie, necessidade de tratamento e a ocorrência de perdas estruturais. Foram acompanhados 49 pacientes com HMI com idade entre 6 e 9 anos, totalizando 588 molares e incisivos com e sem alterações, que receberam tratamento preventivo e proteção com CIV quando indicados. As coletas de dados foram realizadas ao longo de 1 ano, com intervalos de 6 meses por meio de exame clínico, moldagem e fotografias. Um questionário semi-estruturado foi respondido pelas mães a fim de identificar a renda familiar, a escolaridade dos responsáveis e a fonte de água consumida. A análise descritiva, o teste Exato de Fisher, Qui-quadrado, McNemar e análise de sobrevida pelo método Kaplan-Meier foram usados para demonstrar os resultados encontrados. Houve uma associação significante entre o agravamento da HMI e o aumento do CPO-D. O nível sócio-econômico do paciente e a presença de DDE na dentição decídua não foram fatores relacionados à severidade. As fraturas pós-eruptivas ocorreram em 7 dos dentes afetados por manchas de HMI. Das restaurações acompanhadas, 16 apresentaram fratura, ocorridas todas nos primeiros molares permanentes. A presença de HMI apresentou estreita relação com a necessidade de tratamento e com o índice CPO-D. Com a grande possibilidade da estrutura afetada por HMI se manter hígida, 95% para manchas e 77% para restaurações atípicas, não se justifica a remoção, por completo ou prematuramente, da área afetada

The goals of this study were to evaluate the clinic prognostic of patients with molar-incisor-hypomineralization (MIH), to establish the relation between its severity with socioeconomic background factors, DMTF index and the presence of dental enamel defects (DED), evaluate the clinical progress of the tooth affected by that injury, to establish the relation with the presence of dental decay, treatment needs and the occurrence of structural lost. The sample was constituted by 49 patients with HMI aging from 6 to 9 years old. This sample presented 588 molars and incisors teeth with and without abnormalities, which received preventive treatment and protection with conventional glass ionomer cement (GIC) when indicated. The data were collected along of one year with one period of 6 month of interval to clinical exam, impressions and intrabucal photographs. A semi-structured questionnaire was answered by the main guardians aimed to identify the family income, level of schooling and the source of water intake. The descriptive analysis, Fisher Exact test, Quis-square, McNemar and the Kaplan-Meier method (survive analysis) were performed. As results, there was a significant association between the MIH progression with the increase of DMTF index. The patient socioeconomic status and the presence of DED in the primary dentition were not the main factors related to severity. There were 7 post eruptive fractures in the group with MIH spots. Of all restored teeth, 16 first permanent molars presented fractures. The presence of MIH showed a close relation with the need of treatment and with the DMTF index. The results showed a high index of success of this treatment in maintain the sound structure of the teeth affected by HMI with 95% related to spots and 77% to atypical restorations procedures. Thus, remove the affected structure completely or prematurely is not a justified clinical decision

Eficiência de um grupo de sala de espera na adesão do aleitamento materno exclusivo / Waiting room group effectiveness in adhesion of exclusive breastfeeding

O aleitamento materno é a estratégia isolada que mais previne mortes infantis, além de promover a saúde da mãe e do bebê. Existem evidências que o leite materno é o alimento ideal para o crescimento e desenvolvimento dos lactentes, além de ser responsável por benefícios importantes à mãe no pós-parto. É recomendado pelo Ministério da Saúde que o aleitamento materno seja exclusivo nos seis primeiros meses de vida do bebê.Objetivo: este estudo determinou se houve validade das ações em grupos de sala de espera com gestantes, na adesão da amamentação exclusiva.Metodologia: a coleta de dados foi realizada na comunidade rural da cidade de São Carlos, SP, Brasil, utilizando um questionário semi-estruturado elaborado com parâmetros na Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e no Distrito Federal PPAM-CDF, 2007, sendo aplicado durante o primeiro mês do lactente e depois de realizado o acompanhamento mensal da nutriz com objetivo de monitorar a amamentação exclusiva.Resultados: dentre os fatores de desmame precoce ou opção pela complementação alimentar, 60% das puérperas relataram motivos oriundos de crendices populares e 20% o fim da licença maternidade.Conclusão: o estudo demonstrou maior período de adesão ao aleitamento materno exclusivo por parte das nutrizes que freqüentaram o grupo de sala de espera, e as mesmas, demonstraram acerca dos benefícios da amamentação para a mãe e filho, maiores conhecimentos do que as que não participaram...

Breastfeeding is the strategy that most prevents child deaths, in addition to health promoting of mother and baby. There is evidence that human breast milk is the ideal food for the growth and development of infants, responsible for important benefits to the mother in the postpartum period. It is recommended by the Ministry of health that breastfeeding is exclusive in the first six months of the infant's life.Aim: this study determined if there was validity of actions in groups of waiting room with pregnant women, the accession of exclusive breastfeeding.Methodology: collection of data was performed in the rural community of the city of São Carlos, SP, Brazil, using a semi-structured questionnaire prepared with parameters used in the “Research of the Prevalence of Breastfeeding in the Brazilian Capital Cities and the Federal District PPAM-CDF, 2007”, being applied during the first month of the infant and after the monthly monitoring of the nursing mother with the objective of monitoring the exclusive breastfeeding.Results: among the factors of early weaning or choice of complementary feeding, 60% of mothers reported reasons from popular superstitions and 20% the end of maternity leave.Conclusion: the study demonstrated a greater period of membership to the exclusive breastfeeding on the part of the mothers who have attended the group of the waiting room, and the same, demonstrated about the benefits of breastfeeding for the mother and son, greater knowledge of what the who did not participate in it...

Considerações sobre o uso do piercing lingual / Considerations regarding the use of tongue piercing

OBJETIVO: Verificar as implicações do uso do piercing lingual em indivíduos da cidade de Araraquara, São Paulo. MÉTODOS: A cidade de Araraquara, São Paulo possui cinco estabelecimentos para colocação de piercing, dos quais apenas dois autorizaram a realização da pesquisa e permitiram acesso a listagem dos usuários de piercing lingual. Os usuários foram contatados pelo telefone. Ao final do estudo a amostra esteve composta por 100 indivíduos de ambos os sexos, maiores de 18 anos, que fazem ou fizeram uso do piercing lingual. Para levantamento das informações utilizou-se um formulário, com seis questões objetivas. Os dados obtidos foram analisados por meio de estatística descritiva. RESULTADOS: Dos participantes, 77 indivíduos usavam piercing lingual há mais de seis meses. O tempo de cicatrização após a colocação do adereço foi abaixo de quatro meses, sendo que, 68 pessoas utilizaram enxaguatórios bucais e 19, além deste, utilizaram analgésicos. Apenas 11 pessoas não apresentaram sintomas após as primeiras semanas decorrentes da colocação do piercing e 56 indivíduos relataram complicações como aumento da salivação, dificuldade na fala, fraturas dentárias, traumas na gengiva ou mucosa e dificuldades na alimentação. CONCLUSÃO: Frente às implicações apresentadas pelo uso do piercing lingual justifica-se o despendimento de esforços na orientação de jovens frente à opção de utilização de piercing na cavidade oral.

OBJECTIVE: Investigated the consequences of tongue piercing in individuals from the city of Araraquara, São Paulo, Brazil. METHODS: In Araraquara there are five piercing shops, but only two agreed to help the research by providing the contact information of customers who had had their tongues pierced. These customers were contacted by telephone. By the end of the research, the sample consisted of 100 individuals from both genders aged 18 years or more. Not all of them still had their tongue piercing. A form with six objective questions was used to collect information. The information was then analyzed by descriptive statistics. RESULTS: From the 100 participants, 77 had been using tongue piercing for more than 6 months. It took less than 4 months for the tongue to heal. Sixty-eight individuals used oral rinses and of these, 19 also used painkillers. Only 11 individuals did not present symptoms after the first weeks using the piercing. On the other hand, 56 individuals reported complications such as increased salivation, speaking difficulties, gingival or mucosal traumas, dental fractures and eating difficulties. CONCLUSION: All these tongue-piercing complications justify efforts to inform the youth about the use of piercing in the oral cavity.