The relationship of enamel defects and caries: a cohort study.

OBJECTIVE: Is there a relationship between enamel defects and early childhood caries? METHODS: A total of 275 children participated in a cohort study from birth to 54 months of age. Enamel defects were determined by the development defects enamel index and dental caries was registered according to the WHO criteria. Data were analyzed using descriptive, analytical techniques, multivariate analysis, and evidence-based tools as number needed to harm (NNH). RESULTS: In the follow up, 224 children were still in the study, 81.3% presented at least one tooth with enamel defect and 44.2% had dental caries. An association was found between enamel defects and dental caries (P = 0.0091). Multivariate analysis showed that night bottle-feeding, absence of fluoride and enamel defects were predictors of dental caries at 18 months (P < 0.05). Enamel defect was the only statistically significant variable to influence the development of caries at 24, 30, 36, and 42 months. At 48 months, the use of fluoride toothpaste had effect on the decrease of caries (P < 0.05). The NNH for enamel defects in relation to dental caries was 3.0, at 24 months and 5.0 at 54 months. CONCLUSION: Enamel defect is a predisposing factor for ECC.

Prevalence of enamel defects related to pre-, peri- and postnatal factors in a Brazilian population.

OBJECTIVES: The aim of this paper is to evaluate the prevalence of enamel defects in infants from a socially and economically poor population and the possible association of these defects with disturbances occurring in the pre-, peri- and postnatal periods of human development. PARTICIPANTS: 117 infants aged between 16 and 18 months old were included in four groups based on gestational age and whether part or full term pregnancy. METHOD: The data were collected in two stages: hospital-based, where gestational and birth records were examined, and home-based, where dental examinations and nutrition were evaluated. The teeth were cleaned and dried with gauze and examined in the open air, avoding direct sunlight in the knee-to-knee position. The enamel defects were coded according to the modified Developmental Defects of Enamel Index. Besides this, body weight and height were considered as anthropometric measures for the evaluation of nutritional status by the National Center for Health Statistics standards. MAIN OUTCOME MEASURES: The data were analyzed using the chi-square and Fisher Exact tests. Besides these tests, logistic regression models were used. RESULTS: The prevalence of enamel defects was 49.6%, higher in the group of male infants (p<0.001). The most frequent type of defect and the most affected surface were, respectively, diffuse opacity (9.5%) and the buccal surface (83.3%), located in the gingival half (6.7%). The logistic regression model showed that educational level, gestational age and intrauterine growth retardation (IUGR), besides a lack of breastfeeding, increased the probability of enamel defects up to level of 5%. CONCLUSIONS: The association between enamel defects and the etiologic factors shown in this study suggest the existence of social influences regarding oral health and teeth development.

Enamel defects and its relation to life course events in primary dentition of Brazilian children: a longitudinal study.

OBJECTIVE: To evaluate the cumulative incidence of enamel defects (ED) and its correlation with life course events such as malnutrition and pre- and postnatal infections, in a cohort of children of low socioeconomic status. METHODS: The children were registered at birth and examined from 12 to 36 months of age. At the baseline, 246 were examined and in the follow-up, 228. The teeth were examined under natural light and dried with gauze. ED was determined by the DDE index. RESULTS: Results show that gender was not significant. The cumulative incidence of ED at the last recall examination was 78.9%. The most prevalent type of defect was diffuse opacity, present on the gingival half of the buccal surface (p < 0.001). For logistic regression analysis maternal infections, intrauterine growth retardation (IUGR), malnutrition and postnatal infections were selected as predictor variables for the occurrence of enamel defects. CONCLUSIONS: The results indicate that life course events such as undernutrition and childhood infections during teeth development may be associated with enamel defects in socioeconomically underprivileged communities and may compromise the oral health-related quality of life.

The influence of enamel defects on the development of early childhood caries in a population with low socioeconomic status: a longitudinal study.

The purpose of this study was to evaluate the influence of enamel defects in the development of dental caries and their association with feeding practices and oral health behaviors in a cohort study of low-socioeconomic children from birth to 36 months of age in northeastern Brazil. Subjects were registered at birth and examined from 12 to 36 months of age. At baseline, 246 children were examined and at follow-up 228. The teeth were clinically examined and dried with gauze under natural light. Enamel defects were determined using the Developmental Defects of Enamel (DDE) index. Dental caries was determined using WHO criteria. Data were analyzed using descriptive and analytical techniques. At 36 months 78.9% infants presented at least one tooth with enamel defects and 25% of the children had at least one decayed tooth. A total of 16.9% teeth with enamel defects had become decayed (p = 0.0001). Opacity with enamel hypoplasia was the defect most frequently associated with dental caries (p = 0.001). Only 0.9% of the teeth without enamel defects developed caries. Multivariate analyses revealed that enamel defects, night breast-feeding and poor oral hygiene habits were predictors of dental caries at 18 and 24 months (p < 0.05). Considering the risk factors evaluated at 30 months of age, the presence of enamel defects was the single predictor of caries development at 36 months (p = 0.0001). Enamel defects are strongly associated with early childhood caries and, therefore, this correlation must be considered when focussing on low-socioeconomic communities.

Delayed primary bone grafting in the hand and wrist after traumatic bone loss.

Seventeen patients had 21 bone graft operations as part of the overall delayed primary management of hand and wrist wounds. All bone graftings were performed within 10 days of injury. Internal or external fixation was used in all cases, and all wounds healed without infection. Complications included a fibrous union at one bone graft juncture and one malunion. Follow-up was from 3 months to 7 years. Successful delayed primary bone grafting requires a well-decompressed and surgically-clean wound, good blood supply, adequate fixation, and secure soft-tissue cover. If these conditions cannot be met, bone grafting should be deferred and performed in the conventional manner. The advantages of delayed primary bone grafting are: primary bone healing, a shorter rehabilitation period, fewer operations, avoidance of wound contracture, and bone grafting in a well-vascularized scar-free bed.