Prenatal, neonatal and postnatal factors and the developmental defects of dental enamel / Fatores pré-natais, neonatais e pós-natais e defeitos de desenvolvimento do esmalte dentário

ABSTRACT Objective: To estimate the prevalence of developmental defects in dental enamel and its possible association with prenatal, neonatal and postnatal conditions in six-year-old schoolchildren in a southern Brazilian municipality. Methods: A cross-sectional study was conducted involving 655 six-year-old schoolchildren. Sociodemographic and health data were collected through interviews with mothers and children's oral examinations at schools. Multivariate analyses were performed using Poisson regression with robust estimator. Results: The prevalence of developmental defects of enamel was 44.0%. Demarcated opacities were the most prevalent, followed by diffuse opacities. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were independently associated with the prevalence of demarcated opacities. Conclusions: The prevalence of developmental defects in dental enamel was 44.0%. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were associated with the prevalences.

RESUMO Objetivo: Estimar a prevalência de defeitos de desenvolvimento do esmalte dentário e sua possível associação com fatores pré-natais, neonatais e pós-natais em escolares de seis anos de idade em um município do sul do Brasil. Métodos: Foi conduzido um estudo transversal envolvendo 655 escolares de seis anos de idade. Os dados sociodemográficos e de saúde foram coletados por meio de entrevistas com as mães e exames bucais das crianças nas escolas. As análises multivariadas foram realizadas por meio de regressão de Poisson com estimador robusto. Resultados: A prevalência de defeitos de desenvolvimento do esmalte foi de 44,0%. As opacidades demarcadas foram as mais prevalentes, seguidas das difusas. Gravidez tardia, escolaridade materna inferior a oito anos, sexo feminino e cor da pele branca da criança foram independentemente associados à prevalência de opacidades demarcadas. Conclusões: A prevalência de defeitos de desenvolvimento do esmalte dentário foi de 44,0%. Gravidez tardia, escolaridade materna inferior a oito anos de estudo, sexo feminino e cor da pele branca da criança estiveram associados às prevalências.

Análisis de la relación entre la hipomineralización incisivo molar y los factores asociados a su etiología / Analysis of the relationship between molar incisor hypomineralization and the factors associated with its etiology

RESUMEN El objetivo de este artículo es analizar la relación entre la hipomineralización incisivo molar (HIM) y los factores asociados a su etiología publicados en la literatura. Material y métodos: El estudio se basó en una búsqueda de estudios epidemiológicos de casos y controles de HIM que describieron un factor etiológico asociado para obtener las odds ratio (OR) necesarias para analizar la prevalencia del factor afectado y su posible papel en la etiología de la condición. Resultados: Ocho artículos cumplieron los criterios para el análisis. La población total analizada consistió en una muestra de 7,901 sujetos, de los cuales 992 tenían HIM. En estos sujetos fueron reportados como factor asociado (FA) para HIM: asma (OR = 4.4954), uso de antibióticos (OR = 5.5348), fiebre (OR = 4.0545) y neumonía. Conclusión: Los resultados del presente estudio sugieren que un FA común a todos los casos de HIM estudiados es un proceso inflamatorio que conduce a una mayor concentración de agentes en el microambiente en el que se desarrollan las células formadoras del esmalte, lo que aumenta la presencia de proteínas en la matriz del esmalte o interfieren con su hidrólisis y eliminación y produce como resultado una deficiente mineralización.

ABSTRACT Hypomineralization enamel of the first permanent molars is the most common developmental abnormalities observed in the teeth. The aetiology of MIH remains unclear and may have a multifactor aetiology. The aim of this paper is to analyze the relationship between MIH and associated factors published in the literature. Material and methods: The study was based on a search for epidemiological case-control studies of MIH that described an associated etiological factor, in order to obtain the odds ratios needed to analyze the prevalence of the factor concerned and its possible role in the etiology of the condition. Results: The initial search produced 50 articles, eight of which met the criteria for the analysis. The total population analyzed consisted of a sample of 7,901 subjects, 992 of whom had MIH (i.e., a prevalence of 12.55%). Asthma was reported as an etiological factor in five papers, which included 474 subjects with MIH with an OR of 4.4954 (p < 0.0001). Antibiotic use was reported as an etiological factor in three papers, which reported on a population of 231 subjects with MIH and OR of 5.5348 (p < 0.0001). Fever was reported as an etiological factor in two papers, involving a population of 176 subjects with MIH and an OR of 4.0545 (p < 0.0001). Pneumonia was reported as an etiological factor in two papers, which dealt with a population of 454 cases of MIH and produced an OR of 2.285 (p < 0.0001). Conclusion: The results of the present study suggest that one etiological factor common to all of the MIH cases studied is an infl ammatory process, in which the presence of agents that cause alterations in ameloblasts can lead to higher concentrations of these agents in the microenvironment in which enamel forming cells develop, thus increasing the presence of proteins in the enamel matrix or interfering with their hydrolysis and removal, producing defects in enamel mineralization.

Signos dentales de la sífilis congénita / Dental signs of congenital syphilis

La sífilis congénita es causada por una bacteria en forma de espiroqueta denominada Treponema pallidum; se transmite de la madre infectadaaal feto. Esta enfermedad causa distintas alteraciones sistémicas, dependiendoen qué fase de la sífilis se infecta el producto. El incremento de casos a nivel mundial hace necesario el estudio de su epidemiología y que se implementen programas de salud que atiendan a la población embarazada, con seguimiento por medio del control prenatal. Se estima que 1.5 por ciento de las mujeres embarazadas a nivel mundial la padecen. Las alteraciones dentales tienen su etiología en la infl amación provocada por la espiroqueta al momento de la amelogénesis; los signos dentales característicos de la sífi lis congénita son los incisivos de Hutchinson, molares de mora y, en menor medida, los caninos de Fournier. El propósito de este trabajo es hacer una revisión de la literatura, enfatizando en las características clínicas de la enfermedad que nos permitan realizar el diagnóstico de la sífilis congénita.

Congenital syphilis is caused by a spirochete bacterium called Treponema pallidum; it is transmitted from the infected mother to the fetus. This disease causes diff erent systemic alterations, dependingon which phase of syphilis the product is infected. The increase incases worldwide makes it necessary to study its epidemiology andto implement health programs that serve the pregnant population, with follow-up through prenatal control. It is estimated that 1.5% of pregnant women world wide suff er from it. Dental alterations have theiretiology in the infl ammation caused by the spirochete at the momentof amelogenesis; the characteristic dental signs of congenital syphilisare Hutchinson incisors, blackberry molars, and, to a lesser extent, Fournier’s canines. The purpose of this paper is to review the literature, emphasizing the clinical characteristics of the disease that may allowus to diagnose congenital syphilis.

Impacto de la posición socioeconómica sobre los defectos de desarrollo del esmalte en dentición primaria / Impact of socioeconomic position on the developmental enamel defects on primary dentition

Introducción y ObjetivoLos defectos de desarrollo del esmalte (DDE) son alteraciones del esmalte dental que resulta de diversosdisturbios durante la amelogénesis.Determinar el impacto de la posición socioeconómica (PSE) sobre los DDE en la dentición primaria deniños escolares de 6 a 9 años de edad.Material y MétodosSe realizó un estudio transversal en 925 escolares de seis a nueve años de edad. El criterio utilizado paraDDE fue el propuesto por la Federación Dental Internacional, específicamente las opacidades marcadasy difusas e hipoplasias, excluyendo fluorosis dental y otras decoloraciones, a través de un examen clínicorealizado por tres examinadores previamente estandarizados (kappa> 0,80). Se utilizó un cuestionariodirigido a las madres/tutores de los niños se recogieron diversas variables sociodemográficas ysocioeconómicas. La PSE fue determinada con la ocupación y escolaridad de los padres. El análisisestadístico se realizó calculando razones de momios con regresión logística en STATA 9.0.ResultadosLa edad promedio fue 7,56±1,13 años y 50,3% fueron varones. El promedio de DDE fue 0,17±0,75, y laprevalencia de 9,9%. En el análisis multivariado de regresión logística, se observó que los momios depresentar DDE en los dientes primarios aumentaron (p<0,05) en los niños de 8-9 años, en los que visitanal dentista con mayor frecuencia y los de peor PSE.ConclusionesEste estudio permitió identificar que la PSE tiene un impacto en la presencia de DDE en la denticiónprimaria. Es necesario realizar más estudios que confirmen esta asociación y clarifiquen la relación,preferentemente de tipo longitudinal.

Introduction and objectiveDevelopmental enamel defects (DED) can be defined as any alteration of tooth enamel resulting fromvarious disturbances during amelogenesis. The objective of this report was to determine the impact ofsocioeconomic position (SEP) on the DEDin primary teeth of 6 to 9 year old school children.Material and MethodsA cross-sectional study in 925 school children from six to nine years old was carried out. The diagnosticcriteria used for DED was proposed by the FDI, specifically marked and diffuse opacities and hypoplasia,excluding dental fluorosis and other discolorations, through a clinical examination conducted by threetrained and calibrated examiners (kappa> 0,80). Sociodemographic and socioeconomic variables werecollected through a questionnaire directed to mothers / guardians of children. Socioeconomic position(SEP) was determined with the parental occupation and schooling. Statistical analysis was performed bycalculating odds ratios with logistic regression in STATA 9.0.ResultsThe mean age was 7,56±1,13 years and 50,3% were male. Average DED was 0,17 ± 0,75, and theprevalence of 9,9%. Multivariate logistic regression analysis indicated that the odds presenting DED inprimary teeth increased (p <0,05) in children between 8-9 years old, visiting the dentist more often andthe worst SEP.ConclusionsThis study has shown that the PSE has an impact on the presence of DED in the primary dentition.Further studies, which are preferably longitudinal, are needed to confirm this association and clarify therelationship.

Frecuencia y severidad de la hipomineralización molar incisal en pacientes atendidos en las clínicas odontológicas de la Universidad de La Frontera, Chile / Frequency and Severity of the Molar Incisor Hypomineralization in Patients Treated at the Dental Clinic of the Universidad de La Frontera, Chile

La Hipomineralización Molar Incisal (MIH) es una alteración del desarrollo dentario, que estaría asociada a causas de origen sistémico, e involucra al menos uno o más primeros molares permanentes, pudiendo estar comprometidos los incisivos. La prevalencia de este síndrome varía en la literatura entre 2,5 a 40 por ciento en la población infantil mundial. El objetivo de este estudio fue determinar la frecuencia y grado de severidad de MIH entre los pacientes atendidos en la Clínica de Odontopediatría de pregrado y postgrado de la Universidad de La Frontera y los posibles factores asociados. Se realizó un estudio descriptivo en 334 niños entre 6 y 13 años de edad. El examen fue realizado por 2 examinadores en las clínicas de la Universidad de la Frontera. Se estableció el diagnóstico, de acuerdo a los criterios establecidos por Weerheijm et al. (2003) y la severidad según a los criterios propuestos por Mathu-Muju & Wright (2006). La prevalencia encontrada correspondió a 16,8 por ciento. De estos, el 57 por ciento mostró signos severos de MIH, el 20 por ciento signos moderados y 23 por ciento signos leves. No hubo diferencias significativas por sexo y edad respecto a la presencia de MIH o su severidad. El 87 por ciento de los afectados reportó antecedentes mórbidos en el período comprendido desde el preparto hasta la primera infancia. Esta patología presenta alta prevalencia en los pacientes muestreados, comparable a la establecida en estudios realizados a nivel mundial.

Molar incisor hypomineralization (MIH) is a tooth development disorder, which would be associated with systemic causes, and involves at least one or more first permanent molars, incisors may be compromised. The prevalence of this syndrome varies in literature between 2.5 to 40 percent of the world's children. The aim of this study was to determine the frequency and severity of MIH between patients attended at the Graduate Pediatric Dentistry Clinic of the Universidad de La Frontera and the possible associated factors. We conducted a descriptive study of 334 children between 6 and 13 years of age. The review was conducted by 2 examiners at the Universidad de La Frontera. The diagnosis, according to the criteria established by Weerheijm et al (2003) and severity according to the criteria proposed by Mathu-Muju & Wright (2006). The prevalence found corresponded to 16.8 percent. Of these, 57 percent showed severe signs of MIH, 20 percent and 23 percent moderate and mild signs respectively. No significant differences by sex and age for the presence of MIH or its severity. 87 percent of those affected reported morbid history in the period from pre-early childhood. This disorder has high prevalence in patients sampled, comparable to that established in studies worldwide.

Limitations of enamel microabrasion technique applied in a pediatric patient: case report / Limitações da técnica de microabrasão em esmalte aplicada em pacientepediátrico: relato de caso clínico

A microabrasão do esmalte é um método não-invasivo que remove defeitos intrínsecos e superficiais dos dentes objetivando melhorar a estética dentária com mínimo de perda estrutural. Este relato de caso descreve uma tentativa para a correção da cor dentária utilizando esta técnica conservativa numa paciente jovem cujo incisivo centralsuperior apresentou uma mancha branco-opaca. Microscopia eletrônica de varredura (MEV) foi realizada de modo a ilustrar o aspecto de vidro lustrado e uma textura lisa da superfície do esmalte microabrasionado. O correto diagnóstico do defeito é uma tarefa difícil ao se considerar esta abordagem conservativa.

Enamel microabrasion is a non-invasive method that removes intrinsic and superficial defects from teeth aimed to improve dental esthetic with minimal loss of dental tissue. This case presentation describes the attempt for teeth color correction utilizing that conservative technique in a young girl whose upper central incisor presented an opaque white stain. Scanning electron microscopy (SEM) was conducted in order to illustrate the glasslike luster and a smooth texture of microabraded enamel surface. The correct diagnosis of defect is a difficult task, when consider this conservative approach.