Development of undergraduate students' diagnostic accuracy for the classification of molar incisor hypomineralization.

INTRODUCTION: One of the major difficulties with respect to molar incisor hypomineralization (MIH) is its classification and differentiation from other enamel development defects (EDDs). The aim of this study was to evaluate diagnostic accuracy in dental students to classify MIH as well as its differentiation from other EDDs by combining conventional theoretical classes and e-learning-assisted pre-clinical practices. METHODS: In this one-group pre-test and post-test study, 59 second-year students assessed 115 validated photographs using the MIH Index on the Moodle learning platform. This index assesses the clinical features and extent of MIH, differentiating it from other EDDs. Students received automatic feedback after the pre-test. Two weeks later, students re-evaluated the same photographs. Both pairwise accuracy and overall diagnostic accuracy were estimated and compared for pre- and post-testing, with the area under the curve AUC, along with 95% confidence intervals (95% CI). RESULTS: The lowest diagnostic accuracy was for the ability to discriminate between white or cream-coloured demarcated opacities and hypomineralization-type defect that is not MIH. The overall pre-test accuracy was AUC = 0.83 and increased significantly post-test to AUC = 0.99 (p < .001). The overall accuracy to discriminate the extent of the lesion also increased significantly post-test (p < .001). CONCLUSION: Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

Characterization of enamel developmental defects in patients with orofacial clefts and their relationship to surgical procedures.

AIMS: This study aimed to characterize the prevalence of development defects of enamel (DDE) in patients with cleft based on the cleft phenotype and explore the relationship between surgical procedures and different types of DDE. MATERIAL AND METHODS: In this cross-sectional study, 290 standardized orthodontic documentation and medical records from a reference hospital were evaluated, which treated patients with: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), cleft palate (CP), cleft median (CM), and considering laterality as unilateral or bilateral. DDE was assessed using the Ghanim Index (2015). Information on surgical intervention periods was obtained from medical records. Statistical analyses were performed using prevalence ratio (PR) for DDE comparisons between cleft phenotypes and surgical procedures. RESULTS: The prevalence of DDE was 77.2%. Demarcated hypomineralization was associated with CP and CLP, while hypoplasia was associated with CLa, especially when bilateral. Hypoplasia was also associated with the labial adhesion surgery. CONCLUSION: Demarcated hypomineralization was the most common DDE in this population, and the cleft phenotype influenced the type of DDE manifested. The lip adhesion surgery increased the chances of hypoplasia manifestation. CLINICAL RELEVANCE: The type of DDE in patients with cleft depends on the cleft phenotype. Understanding this susceptibility enables the multidisciplinary team to monitor dental development, thus allowing early diagnosis and timely referral to the pediatric dentist and better prognoses.

Evidence Linking PPARG Genetic Variants with Periodontitis and Type 2 Diabetes Mellitus in a Brazilian Population.

The peroxisome proliferator-activated receptor gamma (PPARG) gene encodes a transcription factor involved in the regulation of complex metabolic and inflammatory diseases. We investigated whether single nucleotide polymorphisms (SNPs) and haplotypes of the PPARG gene could contribute with susceptibility to develop periodontitis alone or together with type 2 diabetes mellitus (T2DM). Moreover, we evaluated the gene-phenotype association by assessing the subjects' biochemical and periodontal parameters, and the expression of PPARG and other immune response-related genes. We examined 345 subjects with a healthy periodontium and without T2DM, 349 subjects with moderate or severe periodontitis but without T2DM, and 202 subjects with moderate or severe periodontitis and T2DM. PPARG SNPs rs12495364, rs1801282, rs1373640, and rs1151999 were investigated. Multiple logistic regressions adjusted for age, sex, and smoking status showed that individuals carrying rs1151999-GG had a 64% lower chance of developing periodontitis together with T2DM. The CCGT haplotype increased the risk of developing periodontitis together with T2DM. The rs1151999-GG and rs12495364-TC were associated with reduced risk of obesity, periodontitis, elevated triglycerides, and elevated glycated hemoglobin, but there was no association with gene expression. Polymorphisms of the PPARG gene were associated with developing periodontitis together with T2DM, and with obesity, lipid, glycemic, and periodontal characteristics.

Molar-Incisor Hypomineralization: Prevalence Comparative Study in 6 Years of Interval.

The aim of this study was to evaluate the prevalence evolution rate of MIH (molar-incisor hypomineralization) after a 6-year period in Araraquara/SP, Brazil. This population-based study evaluated MIH in 545 schoolchildren (6-12 years of age) and other associated alterations, dental caries and dental fluorosis (DF). A semistructured questionnaire was sent to the schoolchildren's parents/guardians with the purpose of identifying the socioeconomic profile. Associations between MIH and the clinical characteristics were analyzed by the Poisson analysis of regression with robust variance, estimating the RPc (crude prevalence ratio) with CI 95%. The level of significance of 5% was adopted. The MIH prevalence in Araraquara/SP in 2016 was 14.3% (n = 78), and at this time, an increase of 2% was observed, in comparison with the data of the first prevalence study conducted in 2010 (12.3%). The mild degree compromise was the most prevalent diagnosis in the affected teeth (82.0%). Among children with MIH, the mean number of affected teeth was 2.78. Of the total number of children with MIH, 32.0% presented alterations in both first permanent molars and permanent incisors. There is no significant association between MIH and dental caries experience on permanent dentition (PRc = 1.141; CI 95% 0.709-1.835) or on primary dentition (PR c = 1.132; CI 95% 0.749-1.709). Children with MIH presented significantly less prevalence of dental fluorosis (PR c = 0.505; CI 95% 0.268-0.950). There is no association between MIH and monthly Brazilian minimal wage income (PR c = 1.130; CI 95% 0.655-1.949). It was concluded that the number of MIH cases had increased, revealing a greater need for defining the etiological factors and establishing a correct diagnosis to make it possible to institute early intervention.

Association Between Frequency and Severity of Dental Fluorosis and Molar Incisor Hypomineralization.

OBJECTIVE: To assess the association between the frequency and severity of dental fluorosis (DF) and molar incisor hypomineralization (MIH) in a fluoridated salt region. STUDY DESIGN: In this retrospective cross-sectional study, we evaluated the buccal, occlusal/incisal, and palatal/lingual surfaces of first permanent molars and permanent incisors of 453 patients aged 13-16 years through intraoral standardized photographs. Two standardized examiners evaluated DF and MIH independently, utilizing the Thylstrup-Fejerskov (TF) index and the MIH index. The statistical analysis was performed using a generalized linear model and logistic regression adjusted for age, sex, and dental caries experience. RESULTS: The MIH frequency at the surface level was lower in the presence of DF (PR= 0.03; P= 0.00, 95% CI: 0.01-0.08). At the surface level, MIH severity was lower among those presenting mild DF (aOR= 0.02; 95% IC: 0.01-0.07). Regarding severe DF, we found no significant difference in MIH severity (P= 0.174). CONCLUSION: MIH frequency and severity tend to be lower in the presence of DF.

Does molar-incisor hypomineralization (MIH) affect only permanent first molars and incisors? New observations on permanent second molars.

BACKGROUND: The second permanent molar plays an important role when considering extraction of first permanent molars severely affected by molar-incisor hypomineralization (MIH). AIM: To assess the association between MIH and enamel hypomineralization of the second permanent molars in terms of presence and severity. DESIGN: In this retrospective cross-sectional study, permanent teeth were evaluated in 453 patients between the ages of 13 and 16 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index and dental caries experience using the DMFT and DMFS indices. Statistical analyses were performed using a linear generalized model and ordinal logistic regression. RESULTS: The most commonly affected teeth by enamel hypomineralization were permanent molars, whereas incisors, premolars, and canines were less affected. The presence of severe defects in the first permanent molars was associated with mild defects in the second permanent molars (OR = 4.01; 95% CI: 2.50-7.77). Enamel hypomineralization was associated with increased caries experience (PR = 5.54; 95% CI: 3.81-9.06). CONCLUSION: Enamel hypomineralization mainly affects the first and second permanent molars. Mild defects in the second permanent molars tend to be more frequent in patients with severe MIH in the first permanent molars. The presence of enamel hypomineralization was associated with higher dental caries experience.

Survival of stainless-steel crowns and composite resin restorations in molars affected by molar-incisor hypomineralization (MIH).

BACKGROUND: Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH). AIM: To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months. DESIGN: In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval. RESULTS: The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2). CONCLUSION: In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats.

Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. OBJECTIVE: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. METHODOLOGY: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). RESULTS: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. CONCLUSION: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Contribution of dentistry in the diagnosis of systemic disorders related to erosive tooth wear / Contribución de la odontología en diagnóstico de trastornos sistémicos relacionados con el desgaste dental erosive / Contribuição da odontologia no diagnóstico de distúrbios sistêmicos relacionados ao desgaste dentário erosivo

Abstract Erosive tooth wear (ETW) is the irreversible loss of dental hard tissue resulting from the chemical-mechanical process. The aim of the present case report was to present two clinical cases of patients affected by ETW arising from different etiological factors. The patients, of the male gender, 9 and 10 years of age presented to the pediatric dental clinic, for routine evaluation. On clinical exam, both patients had no caries lesions, but some lesions suggestive of ETW, which had aspects such as a translucent halo around the occlusal surface of teeth, in addition to "cupping" lesions - mainly in the cusp region, and loss of tooth enamel (by volume). The lesions were restricted to enamel, and the patients showed no dental hypersensitivity. From the dental clinical exam and anamnesis, the two patients were found to have similar tooth structure loss, with diagnosis of ETW. However, in one patient the etiology was extrinsic due to diet, and in the other, it was intrinsic due to gastroesophageal reflux disease (GERD). The latter patient was referred to a specialist for evaluation of the systemic condition, and GERD was diagnosed. It was concluded that dentists play an important role, as coadjuvant in the diagnosis of health problems related to ETW. Therefore, meticulous clinical exams must be performed to establish the correct diagnosis, because swift intervention in the clinical cases presented had a positive impact on halting the erosive process.

Resumen El desgaste dental erosivo corresponde a una pérdida irreversible de tejido duro dental resultante de un proceso químico-mecánico. Este artículo tuvo como objetivo presentar dos casos clínicos de pacientes afectados por desgaste erosivo con diferentes factores etiológicos. Pacientes varones, de 9 y 10 años, acudieron a la clínica dental de odontopediatría para evaluación de rutina. A la exploración clínica, ambos pacientes no presentaban lesiones cariosas y algunas lesiones sugestivas de erosion que presentaban aspectos como un halo translúcido alrededor de la superficie oclusal del diente, además de puntos de punción principalmente en la región cuspídea (lesiones en ventosa) y pérdida del volumen del esmalte dental. Las lesiones se restringieron al esmalte y los pacientes no presentaron hipersensibilidad dentaria. Del examen clínico odontológico y de la anamnesis se aprecia que los dos pacientes presentaban similar pérdida estructural, con diagnóstico de desgaste erosivo, pero un paciente tenía una etiología extrínseca, por alimentación y otro, intrínseco, por trastorno gastroesofágico (TGRE). El paciente fue derivado al especialista para evaluación de la condición sistémica y se diagnosticó la TGRE. Se concluye que el odontólogo tiene un papel importante, como coadyuvante en el diagnóstico de los trastornos de salud relacionados con el desgaste erosivo. Por tanto, se debe realizar un examen clínico minucioso para establecer el diagnóstico correcto, ya que la rápida intervención en los casos clínicos presentados, incidió positivamente en la parálisis del proceso de erosión.

Resumo O desgaste dentário erosivo corresponde a uma perda irreversível do tecido duro dentário resultante de um processo químico-mecânico. O presente artigo teve por objetivo apresentar dois casos clínicos de pacientes afetados pelo desgaste erosivo com fatores etiológicos distintos. Os pacientes do gênero masculino, com 09 e 10 anos, compareceram à clínica odontológica de odontopediatria para avaliação de rotina. Ao exame clínico, ambos os pacientes apresentavam ausência de lesão de cárie e algumas lesões sugestivas de erosão que apresentavam aspectos como halo translúcido ao redor da superfície oclusal do dente, além de pontos socavados principalmente na região de cúspide (lesões de "cupping") e perda do volume do esmalte dentário. As lesões estavam restritas ao esmalte e os pacientes não apresentavam hipersensibilidade dentária. A partir do exame clínico odontológico e anamese pode-se constatar que os dois pacientes apresentavam perdas estruturais semelhantes, com diagnóstico de desgaste erosivo, porém um paciente apresentava etiologia extrínseca, pela alimentação e outro, intrínseca, por distúrbio gastroesofágico (DGRE). O paciente foi encaminhado ao especialista para avaliação do quadro sistêmico, sendo diagnosticado o DGRE. Conclui-se que o cirurgião-dentista tem um papel importante, como coadjuvante no diagnóstico de distúrbios de saúde relacionados ao desgaste erosivo. Portanto, um exame clínico de maneira minuciosa deve ser realizado para estabelecer o diagnóstico correto, visto que, a rápida intervenção nos casos clínicos apresentados, impactaram de forma positiva na paralisação do processo erosivo.

Clinical changes in the severity of dental fluorosis: a longitudinal evaluation.

BACKGROUND: Dental fluorosis (DF) has been one of the most prevalent pediatric dental conditions associated with aesthetic concern and treatment needs. This study aimed to identify the longitudinal clinical change in the severity of DF in 8-12-year-old children and its association with gender, age, severity, and tooth type. METHODS: This observational study assessed the dental aspects of the 92 Colombian children in 2015 (mean age at beginning 9.71 years ± 1.23) and 2018 (mean age 13.69 years ± 1.41), from an area with high DF prevalence. DF was recorded in all permanent teeth by two calibrated examiners using the Thylstrup and Fejerskov Index (TFI). DF severity change (maximum-TFI-score) was analyzed with descriptive analysis at the tooth level. Associated factors were evaluated with the generalized linear model, binomial family, and logarithmic link function. RESULTS: TFI scores ranged between 1 (very mild) to 6 (severe), being score 2 (41.7%) the most prevalent. After three years, 29.6% of the teeth presented score reduction, 24.1%, increased and 46.3% did not change; the significant association was related to increasing of the basal TFI = 1 score (44.2%) (RR = 9.7; 95% CI 1.7-56.5; p = 0.01) and with canines, premolars and second-permanent-molars teeth group (RR = 3.3; 95% CI 1.9-5.6; p = 0.005). CONCLUSION: The present study based on clinical features about DF confirms the dynamic post-eruptive nature of this condition. After three years of follow-up, a considerable proportion of the teeth changed to a higher score. Furthermore, the canines, premolars, and second-permanent-molars showed a higher incidence of an increase in severity of TFI score.

Inheritance pattern of molar-incisor hypomineralization.

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.

Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial.

OBJECTIVE: To evaluate the influence of fluoride varnish (FV) therapies or resin infiltration (RI) to maintain the structural integrity of Molar Incisor Hypomineralization (MIH) -affected teeth. METHODS: Fifty-one children aged 6-12 years with at least one incisor and one first permanent molar with yellow/brown MIH opacities were included. Patients were randomly allocated into three groups: FV - Fluoride Varnish (Duraphat); FV+etch - Fluoride Varnish (Duraphat) after enamel etching with 37% phosphoric acid; or RI - Resin Infiltration system (Icon). Opacities were monitored for 18 months. The primary outcome was the loss of integrity due to post-eruptive enamel breakdown (PEB). Covariables included sex, age, DMFT index, opacity colour, plaque index, number of MIH-affected teeth, and number of MIH-affected surfaces. Fisher's Exact was used to test the association of treatments with PEB, the Kaplan-Meyer method analysed the survival rates and Cox-regression determined which covariables would predict failure (α=0.05). RESULTS: From a total of 235 teeth, the PEB rate for RI (6.1%) was significantly lower (p<0.05) than FV (17.9%; OR 3.0, 95%CI 1.07, 8.48) and FV+etch (17.3%; OR 3.1, 95%CI 1.13, 8.73). DMFT index >3, brown opacities, cusp involvement, and age between 6-8 years predicted PEB (p<0.05). CONCLUSIONS: Resin infiltration positively influenced the structural integrity maintenance of MIH-affected teeth by decreasing the risk of enamel breakdown over18 months follow-up. Registry of Clinical Trials (RBR-8wwk3n). CLINICAL RELEVANCE: Resin infiltration proved to be a more efficacious intervention to maintain the structural integrity of MIH-affected teeth than fluoride varnish therapies.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Aesthetical perception of dental fluorosis in a Colombian low income community / Percepção estética da fluorose dentária em uma comunidade colombiana de baixa renda / Percepción estética de la fluorosis dental en una comunidad colombiana de bajos ingresos

Abstract Introduction and objective: The Dental Fluorosis (DF) is a development defect of enamel resulting from overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis (DF) in a low-income community with high DF prevalence. Materials and methods: A cross-sectional study was conducted with 171 Colombian schoolchildren aged 8 to 12 years living in low socioeconomic community (El Cedro, district of Ayapel, Córdoba, Colombia). After receiving authorization, the students were examined for DMFT and dmft indexes (WHO criteria), and for DF (TF index). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA). Data analysis was carried out using descriptive statistics, the chi-square test, the Student´s t-test, the one-way ANOVA test, and linear regression at a significance level of p ≤ 0.05. Results: The prevalence of DF in this sample was 84.8% (n=145). Only the presence of caries (DMFT/ deft≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the report of pleasant color domain. The number of teeth affected by DF had a significant positive correlation with mean overall perception of dental health. Conclusion: The presence of mild DF in children with low socioeconomic status, from a population with a high prevalence of the condition, did not seem to have an impact on the report of pleasant color of teeth domain.

Resumo Introdução e Objetivo: A fluorose dentária (FD) é um defeito de desenvolvimento do esmalte decorrente da sobre-exposição ao flúor e pode comprometer esteticamente o paciente. O presente estudo se propõe a investigar a relação entre percepção estética e fluorose dentária em uma comunidade de baixa renda com alta prevalência de FD. Materiais e métodos: Foi realizado um estudo transversal com 171 escolares colombianos de 8 a 12 anos de idade, moradores de uma comunidade de baixa renda (El Cedro, distrito de Ayapel, Córdoba, Colômbia). Após receber autorização, os estudantes foram examinados para os índices CPOD e ceod (OMS) e para o FD (TF index). As percepções estéticas foram verificadas pelo "Child Perception Questionaire about Teeth Appearence" (CQATA). A análise dos dados foi realizada por meio de estatística descritiva, teste do qui-quadrado, teste t de Student, teste ANOVA one-way e regressão linear em nível de significância de p ≤ 0,05. Resultados: A prevalência de FD nesta amostra foi de 84,8% (n = 145). Apenas a presença de cáries (CPOD/cpod≠0) teve um impacto significativo nas percepções estéticas. Uma taxa significativamente menor foi encontrada em meninas para o relato de domínio de cor agradável. O número de dentes afetados pela FD teve correlação positiva significativa com a percepção geral da saúde bucal. Conclusão: A presença de FD leve em crianças com baixo nível socioeconômico, de uma população com alta prevalência da doença, não parece ter impacto na satisfação com a coloração dos dentes.

Resumen Introducción y objetivo: La fluorosis dental (FD) es un defecto en el desarrollo del esmalte como resultado de la sobreexposición al fluoruro y puede comprometer estéticamente al paciente. Este estudio tiene como objetivo investigar la relación entre la percepción estética y la fluorosis dental en una comunidad de bajos ingresos económicos y con alta prevalencia de FD. Materiales y métodos: Se realizó un estudio transversal con 171 escolares de 8 a 12 años que viven en una comunidad socioeconómica baja (El Cedro, distrito de Ayapel, Córdoba, Colombia). Los estudiantes fueron examinados para caries dentaria (índices DMFT y dmft (criterios de la OMS) y para el fluorosis dentaria (índice TF). La percepción estética se verifico con el cuestionario sobre percepciones de los niños sobre la apariencia de los dientes (CQATA). El análisis de los datos se realizó mediante estadísticas descriptivas y las pruebas de chi cuadrado, t de Student, ANOVA de una vía y la regresión lineal (p ≤ 0.05). Resultados: La prevalencia de FD fue de 84.8% (n = 145). Solo la presencia de caries (DMFT/deft ≠ 0) tuvo un impacto significativo en las percepciones estéticas. Se encontró una tasa significativamente más baja en las niñas para el informe acerca de color agradable. La cantidad de dientes afectados por FD tuvo una correlación positiva significativa con la percepción general de la salud dental. Conclusión: La presencia de FD leve en niños con bajo nivel socioeconómico, en una población con una alta prevalencia de este defecto de esmalte, no pareció tener tuvo un impacto en la aceptción aceptar la apariencia del color de los dientes.

Circulating lymphocytes and monocytes transcriptomic analysis of patients with type 2 diabetes mellitus, dyslipidemia and periodontitis.

Type 2 diabetes mellitus (T2DM), dyslipidemia and periodontitis are frequently associated pathologies; however, there are no studies showing the peripheral blood transcript profile of these combined diseases. Here we identified the differentially expressed genes (DEGs) of circulating lymphocytes and monocytes to reveal potential biomarkers that may be used as molecular targets for future diagnosis of each combination of these pathologies (compared to healthy patients) and give insights into the underlying molecular mechanisms of these diseases. Study participants (n = 150) were divided into groups: (H) systemically and periodontal healthy (control group); (P) with periodontitis, but systemically healthy; (DL-P) with dyslipidemia and periodontitis; (T2DMwell-DL-P) well-controlled type 2 diabetes mellitus with dyslipidemia and periodontitis; and (T2DMpoorly-DL-P) poorly-controlled type 2 diabetes mellitus with dyslipidemia and periodontitis. We preprocessed the microarray data using the Robust Multichip Average (RMA) strategy, followed by the RankProd method to identify candidates for DEGs. Furthermore, we performed functional enrichment analysis using Ingenuity Pathway Analysis and Gene Set Enrichment Analysis. DEGs were submitted to pairwise comparisons, and selected DEGs were validated by quantitative polymerase chain reaction. Validated DEGs verified from T2DMpoorly-DL-P versus H were: TGFB1I1, VNN1, HLADRB4 and CXCL8; T2DMwell-DL-P versus H: FN1, BPTF and PDE3B; DL-P versus H: DAB2, CD47 and HLADRB4; P versus H: IGHDL-P, ITGB2 and HLADRB4. In conclusion, we identified that circulating lymphocytes and monocytes of individuals simultaneously affected by T2DM, dyslipidemia and periodontitis, showed an altered molecular profile mainly associated to inflammatory response, immune cell trafficking, and infectious disease pathways. Altogether, these results shed light on novel potential targets for future diagnosis, monitoring or development of targeted therapies for patients sharing these conditions.

Bruxism Throughout the Lifespan and Variants in MMP2, MMP9 and COMT.

Bruxism is a masticatory muscle activity characterized by grinding of the teeth and clenching of the jaw that causes tooth wear and breakage, temporomandibular joint disorders, muscle pain, and headache. Bruxism occurs in both adults and children. Clinical characteristics and habits were evaluated in an adult sample. Moreover, we used DNA samples from 349 adults and 151 children to determine the presence of association with specific genes. Genomic DNA was obtained from saliva. The markers rs2241145 and rs243832 (metalloproteinase 2 (MMP2)), rs13925 and rs2236416 (metalloproteinase 9 (MMP9)), and rs6269 (cathecol-o-methyltransferase (COMT)) were genotyped. Data were submitted to statistical analysis with a significance level of 0.05. In adults, in univariate logistic regression, presence of caries, attrition, and use of alcohol were increased in bruxism individuals (p < 0.05). In addition, in adults, there was an association between bruxism and MMP9 (rs13925, p = 0.0001) and bruxism and COMT (rs6269, p = 0.003). In children, a borderline association was observed for MMP9 (rs2236416, p = 0.08). When we performed multivariate logistic regression analyses in adults, the same clinical characteristics remained associated with bruxism, and orthodontic treatment was also associated, besides rs13925, in the AG genotype (p = 0.015, ORa: 3.40 (1.27-9.07)). For the first time, we provide statistical evidence that these genes are associate with bruxism.

Esthetic rehabilitation of anterior teeth with molar-incisor hypomineralization and dental fluorosis: a case report.

This case report describes the treatment of a patient who had molar-incisor hypomineralization associated with dental fluorosis, a diagnosis established through a comprehensive review of the clinical record, an intraoral clinical examination, and assessment of photographic records. First, dental hypersensitivity was treated with fluoride varnish, which was applied separately to each dental quadrant. Subsequently, the functional and esthetic reconstruction of the permanent maxillary central incisors was completed in a single session through the placement of direct composite resin veneers. After the treatment, the patient was reexamined monthly for 12 months to evaluate the durability of the restorations. At the 12-month follow-up, no fractures or pigmentations were observed, and only a slight loss of brightness of the restorations was noted. The dental hypersensitivity had been eliminated. When an adhesive restorative technique with composite resin is well executed, it is possible to obtain satisfactory and long-lasting esthetics and relief of painful symptoms.

Esthetic reconstruction of teeth with enamel hypoplasia.

Hypoplasia is an enamel developmental defect characterized by a quantitative disturbance in the formation of mineralized tissue. Among its etiologic factors are local and systemic causes, trauma and dental infections being the most common. This case report presents the functional and esthetic rehabilitation of a 12-year-old boy diagnosed with hypoplasia in the maxillary central incisors. His chief complaints were the unesthetic appearance and sensitivity of the affected teeth. The teeth were restored with composite resin placed with the aid of a direct silicone palatal guide, and the patient was followed up for 12 months. The treatment plan allowed the restoration and improvement of function and esthetics, resulting in patient satisfaction.

Prenatal exposure to gestational diabetes mellitus increases developmental defects in the enamel of offspring.

BACKGROUND AND OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with short- and long-term maternal and perinatal repercussions. Our objective was to evaluate the long-term consequences of intrauterine exposure to hyperglycemia on Developmental Defects of Enamel (DDE) in offspring. RESULTS: Overall, 50 children of women with GDM and 250 children of normoglycemic women participated, the latter serving as controls. Children were examined at the age between 3 and 12 years. In addition to physical examination, two independent observers examined and rated photographs to identify specific types of DDE in a blinded fashion. Among offspring of mothers with GDM, rates of DDE (all types combined) and hypoplasia (specific type) were significantly higher (p<0.001, p = 0.04), in comparison to offspring of normoglycemic mothers. Considering only the affected teeth (1060 in GDM category; 5499 in controls), rates of DDE (all types combined) were significantly higher for total teeth (p <0.001) and deciduous teeth (p<0.001), but not permanent teeth. In specific types of DDE involving deciduous teeth, rates of demarcate opacity were significantly higher (p<0.001; canine and 2nd mandibular molars) and hypoplasia (p <0.001; 2nd maxillary molars and 2nd mandibular molars). In permanent teeth, the rate of diffuse opacity in association with GDM was significantly higher (p<0.001; maxillary central incisors and 1st maxillary molars). CONCLUSION: GDM was associated with the adverse effects of DDE on offspring. This study lays the foundation for future studies to determine the impact of GDM on long-term risk of DDE.