Challenges of Using Scoring Systems for the Assessment of Molar Incisor Hypomineralisation.

The dental professional is exposed to complex challenges daily, posed by molar incisor hypomineralisation (MIH). These range from understanding its etiology through to determining the most effective strategies for clinical management of the problem. Beyond any doubt, the choice of the diagnostic scoring system to be used for recording the condition is included among these challenges. To a certain degree, this is understandable since the development of specific diagnostic tools for recording the occurrence of MIH takes place parallel to the ongoing discoveries about the problem. Therefore, the aim of this chapter is to present different MIH scoring systems that have previously been proposed in the literature for detecting MIH and discuss their applications, advantages, and limitations.

Implications of Histological and Ultrastructural Characteristics on the Chemical and Mechanical Properties of Hypomineralised Enamel and Clinical Consequences.

Molar incisor hypomineralisation (MIH) is a qualitative type of enamel defect, which occurs due to a failure in the biomineralisation process of the enamel organic matrix during amelogenesis. The tooth enamel affected by MIH shows changes in its chemical, structural, and mechanical properties, leading to different clinical repercussions. The color of MIH opacities varies from opaque white to yellow/brown, and elemental analyses of these lesions show a lower calcium and phosphate content, minerals that are more abundant in sound enamel. Furthermore, the incorporation of other molecules occurs, such as carbonate, a component that provides a greater degree of solubility, thus making hypomineralised enamel more susceptible to posteruptive fractures. At a structural level, the layer of hydroxyapatite crystals appears to be disorganized, with morphological changes, implying a greater degree of porosity in the structure. The increase in porosity of the structure may be associated with dental hypersensitivity, a common clinical repercussion among patients with MIH. Among the mechanical properties, a decrease in hardness and modulus of elasticity occurs, and this also makes the enamel more fragile. Deficiency in biomineralisation can be caused by changes in the function of ameloblasts or by failures at the intercellular junction that result in lower activity of proteases such as MMP-20 and KLK4. The increase in proteins in the organic matrix of enamel impairs the growth and incorporation of minerals into the hydroxyapatite crystals, so that the enamel becomes hypomineralised and has larger organic content, thus having an impact on its properties. These changes present in the enamel with MIH help to explain the clinical repercussions caused by this condition.

Understanding the Enamel Disintegration and Posteruptive Breakdown of Demarcated Opacities on Molar Incisor Hypomineralisation.

This review aims to present scientific knowledge regarding the demarcated opacities of molar incisor hypomineralisation (MIH) and factors that clarify the occurrence of posteruptive enamel breakdown. The demarcated opacities have distinct boundaries with the adjacent nonaffected enamel and may vary in color among white, creamy, yellow, and brownish. The hypomineralised enamel is more porous and less organized than the nonaffected enamel. As a result of the reduced mineral content and higher protein content, the hypomineralised enamel shows a progressive reduction in its mechanical properties according to the opacity feature. Chemically, the protein content of MIH opacities is abnormally high, mainly composed by albumin, which is a serum protein usually not found in mature enamel. The highest protein content is seen in brown opacities, followed by yellow and white opacities, both with higher protein content than nonaffected enamel. The fact that the hypomineralised enamel is more fragile than the nonaffected enamel is supported not only by laboratorial findings but also by clinical prospective studies that observed an aggravation of MIH over time, as well as the correlation between the color of the demarcated opacities and the risk of posteruptive enamel breakdown. A better understanding about the microstructure of the hypomineralised enamel has relevant implications for the clinical approach of the condition. In the clinic, besides a comprehensive assessment of anamnesis and clinical data, it is advisable to record the color and the location of the opacities by tooth surface in order to support the treatment decisions and estimate a prognosis for MIH patients.

Molar Incisor Hypomineralisation: A Recent Condition or a New Perception?

The condition known as molar incisor hypomineralisation (MIH) has been featured in the dental literature for some time. However, the condition itself, characterized by demarcated opacities, had been observed and documented in various forms before the official terminology was coined. The awareness and understanding of MIH have increased over the years, and there has been ongoing research to explore its prevalence, etiology, clinical implications, care, and treatment. In summary, MIH is not a recent condition, but the terminology and recognition of this dental phenomenon have been refined and formalized in the relatively recent past. This chapter reflects on our clinical experience, juxtaposing it with information from scientific literature and personal insights, as well as identifying gaps in understanding this enamel defect. Furthermore, another aim was to foster contemplation for potential research advancements in the MIH field.

Optical coherence tomography and gray scale digital analysis as noninvasive techniques for evaluating molar-incisor hypomineralization severity: A comparative study with microcomputed tomography.

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel characterized by demarcated opacities present in permanent first molars and other teeth. It is considered a major clinical challenge in dentistry because it makes affected teeth more susceptible to fractures and dental caries. Its diagnosis is mainly clinical and there are few technological resources that allow for a more accurate diagnosis, especially with respect to the depth of the defect in the dental enamel. In this context, optical coherence tomography (OCT), which is routinely used in ophthalmology, can produce images of the depth of the dental enamel, making it a promising method. In this study, 33 teeth with different MIH severities were evaluated using OCT and microcomputed tomography (microCT). Semi-quantitative methods of grayscale pattern analysis were used to compare images obtained from different severities of MIH with the mineral density obtained through microCT. MicroCT evaluation revealed that hypomineralized enamel had a significantly lower mineral density than intact enamel. However, this difference was not observed between the mild and severe MIH lesions. In the OCT evaluation, significant differences were observed between the intact and hypomineralized enamel, and the gray value comparison provided a method for quantitative differentiation between the two. This study suggests that OCT could be a useful adjunct to traditional diagnostic methods for MIH, offering a noninvasive approach to evaluate enamel defects. RESEARCH HIGHLIGHTS: Combining optical coherence tomography with grayscale digital analysis shows potential as a promising method for diagnosing molar-incisor hypomineralization and assessing its level of severity.

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.

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.

Enamel Developmental Defect Masking on Central Incisor with Infiltrant Resin.

The aim of this paper is to present a case of masking of a hypoplastic lesion using the infiltrating resin technique, without use of drilling or any loss of tooth structure. A 22-year-old female patient complained of a noncarious white spot on the buccal surface of the upper right central incisor which affected the esthetics of her smile. Despite the tooth discoloration, the tooth structure was intact, with no depressions, cracks, or grooves. During the anamnesis, she reported that the white spot had been present since childhood. On the basis of the information provided by the patient and collected during intraoral clinical examination, it was determined that the stain was suggestive of enamel hypoplasia. The treatment proposed to the patient was the application of infiltrating resin to mask the hypoplasia on the surface of the tooth enamel without any loss of tooth structure. In this case, Icon infiltrating resin proved to be efficient in masking the hypoplastic lesion. The final appearance of the treated tooth was satisfactory, with homogeneity and gloss on the surface, which minimized the characteristics of an unpleasant smile.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries.

This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Dentists' Knowledge and Clinical Experience towards Molar-Incisor-Hypomineralization in Iran

ABSTRACT Objective: To determine the knowledge and clinical experience of dentists regarding MIH in Kerman/Iran. Material and Methods: In this cross-sectional study, a census sampling method was used, and all dentists registered in Kerman medical council were asked to participate in the study. A validated and reliable researcher administered questionnaire was used to determine participants' demographic characteristics, knowledge, and clinical experience. The association between knowledge score and demographic variables was determined using an independent t-test and ANOVA. The level of significance was set as 0.05. Results: Overall, 400 specialized and general dentists in Kerman completed the questionnaire. The mean knowledge score of dentists was 6.6±1.9 of 11. Female dentists' knowledge was higher than male dentists (p<0.05). General dentists had a higher level of knowledge regarding MIH compared to specialists (p<0.05). Overall, 79.5 % had been faced with MIH during their practice years. After confronting MIH teeth, 48.8% of dentists referred patients to specialists for treatment. Providing aesthetics was considered the most difficult part of treatment (43.2%). Resin composite was the most favorable dental material for treating MIH (60.9%). Conclusion: Although most dentists in Kerman had encountered MIH defects during their clinical practice, they did not have enough knowledge of the defect and required education on all aspects of MIH diagnosis and management. Younger dental practitioners, general dentists and females presented higher knowledge of MIH.

Evaluating the changes in molar incisor hypomineralization prevalence: A comparison of two cross-sectional studies in two elementary schools in Mexico City between 2008 and 2017.

BACKGROUND: Little information is available on the trends over time of the prevalence of molar incisor hypomineralization (MIH). This condition may be preventing dental caries decline. AIM: (a) To compare the prevalence of MIH, in Mexico City schoolchildren, evaluated in 2008 with a group evaluated in 2017, (b) to identify the association of MIH with dental caries, and (c) to assess the mother's perception of her child's oral health status. DESIGN: Two cross-sectional studies performed in 2008 and in 2017 were compared. The oral examiner and the selected schools were the same in both surveys. RESULTS: A total of 549 schoolchildren were evaluated. The prevalence of MIH in the first survey was 20.3%, and 31.9 % in the second survey, (p = .002). Children with MIH were more likely to have dental caries. The odds ratio was 2.24 (p = .036) and 4.18 (p ˂ .001) in the first and second surveys, respectively. Mothers of children with MIH perceived worse oral health status of their children than the mothers whose children did not have MIH (odds ratio = 4.47, p ˂ .001). CONCLUSION: The findings portray a clear increase in prevalence of MIH and highlight the need for increased awareness about this condition among dentists and the general population.

Prevalence of Molar Incisor Hypomineralisation Among School Children aged 7-12 years in Tunis, Tunisia

Abstract Objective: To evaluate the prevalence and the characteristics of Molar Incisor Hypomineralisation (MIH) in 7-12-year-old children in Tunis, Tunisia. Material and Methods: This study was designed as a cross-sectional study, in which school children aged 7 to 12 years were included. A total of 510 children (257 girls and 253 boys) who had their first permanent molar and incisors were evaluated using the 2003 European Academy of Paediatric Dentistry (EAPD) recommendation criteria were examined. Descriptive data analysis and Pearson's chi-squared test were performed (p<0.05). Results: A total of 510 children were included in the study. MIH was present in 35.4 % of our study population. Boys exhibited slightly higher MIH (19,4%) and Post Eruptive Breakdown (PEB) (7,3%) prevalence compared to girls, but the difference was not statistically significant (p=0.07). Moreover, demarcated opacities were more prevalent than PEB. More precisely, the main prevalence without PEB was MIH with white/creamy demarcated opacities, which was more frequent than yellow/brown demarcated opacities (p<0.05). Conclusion: The prevalence of MIH in Tunis was 35.4%, with no difference between girls and boys. The main MIH type prevalence was white/creamy demarcated opacities without PEB.

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization.

This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation / Prevalencia y Severidad de Caries Dental y Fluorosis en Niños de 8 Años con o Sin Suplementos de Flúor

ABSTRACT: One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.

RESUMEN: Una de las medidas más efectivas y estudiadas en la prevención de caries es el uso de fluoruros, que tiene la propiedad de reducir su incidencia y severidad. 75 % de la población chilena lo recibe al incluirlo en el agua potable. La OMS en 1984 recomendó el uso de leche como un vehículo alternativo. En Chile, el Programa de Alimentación Escolar con leche fluorada fue implementado en 1994 como alternativa en zonas rurales sin fluoruro en el agua. El objetivo de este estudio fue comparar la prevalencia y severidad de la caries dental y la fluorosis dental en niños de 8 años en tres escuelas públicas, con suplementación de fluoruro en el agua potable o en la leche y con aquella que no tiene ningún programa de fluoración. Estudio epidemiológico, descriptivo, comparativo, observacional y de corte transversal con una muestra de 140 niños de 8 años, sin enfermedades sistémicas y que han vivido en el mismo lugar desde su nacimiento: 50 escolares en el área con agua fluorada, 40 en el área con leche fluorada y 50 en la zona sin suplementación de fluoruro. El porcentaje de niños libres de caries fue obtenido con la metodología descrita por la OMS, usando índices ceo-d y CPO-D para evaluar severidad. Para cuantificar la prevalencia y severidad de la fluorosis dental se ocupó el índice de Dean. Niños libres de caries fueron 38 % en la comunidad con agua fluorada (CWF); 0 % en la comunidad con leche fluorada (FSFP) y 10 % en la comunidad sin programa de fluoración (CNF). La diferencia entre CWF y CNF es estadísticamente significativa (p<0,05). La prevalencia de fluorosis es significativamente mayor en CWF (48,8 %) que FSFP (35 %) y CNF (16 %). La contribución del fluoruro en el agua potable causa una disminución en la prevalencia y severidad de la caries dental en niños de 8 años, y un aumento en la prevalencia de fluorosis dental.

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.

Breakdown of demarcated opacities related to molar-incisor hypomineralization: a longitudinal study.

OBJECTIVES: This prospective longitudinal study aimed to evaluate if the occurrence of post-eruptive breakdown of demarcated opacities in hypomineralized teeth is influenced by the color or location of the opacity. MATERIALS AND METHODS: Patients diagnosed with molar-incisor hypomineralization (MIH) between 2012 and 2014 were eligible. Two calibrated examiners performed the initial and follow-up evaluations according to European Academy of Paediatric Dentistry (EAPD) criteria. Sixty-five patients were included. Fifty-eight (89.2%), with a mean age of 8.8 years (SD: 1.4), were reassessed after 1 year. Two hundred and nine of 1155 tooth surfaces were considered for the study: 86 with white opacity (OP-W), 91 with yellow opacity (OP-Y), and 32 with enamel breakdown (EB). RESULTS: From the OP-W, OP-Y, and EB, 14, 27.5, and 46.9% worsened to breakdown exposing dentin, atypical restoration, or extraction (DB + RA or EXT), respectively. Yellow opacities tended to be more prone to breakdown than white opacities. The occurrence of EB, DB + AR, or EXT was not influenced by the location (p = 0.25). CONCLUSIONS: The color of the opacity seems to play an important role on the occurrence of fracture and should be considered as a potential predictor. CLINICAL RELEVANCE: Dentists should be aware that demarcated opacities related to MIH tend to fracture over time. Moreover, children with MIH should be seen at shorter intervals.

Trauma in primary teeth and its effect on the development of permanent successors: a controlled study.

Objective: This controlled study investigated the occurrence of sequelae to permanent successors (SPS) following traumatic dental injury in primary teeth (TDIp). Additionally, this study evaluated whether TDIp is a risk factor for SPS, with a focus on an association between SPS and the child's age and type of trauma. Materials and methods: The trauma group (TG) consisted of permanent teeth, whose antecessors had suffered TDIp, in a population of children with complete eruption of permanent teeth. The control group (CG) consisted of permanent teeth from the same individuals, whose antecessors had not suffered TDIp. There were 214 cases of TDIp with their respective permanent teeth. In the CG 247 permanent teeth, whose antecessor had not suffered TDIp, were included. Data concerning such teeth and when TDIp occurred (in terms of the child's age) and types of SPS were collected. The chi-square test, regression logistic with generalized estimating equations (GEE) test, and risk analyses were applied to investigate the associations. Results: Overall, 29% of the permanent teeth in the TG presented SPS. This was compared to the development disturbances in the CG, which was 7%. The TG demonstrated the highest risk for SPS (OR, 5.388; p = .0001). The discolouration of enamel (37%) was the most common type of SPS found. SPS was more prone to occur in permanent teeth whose antecessors had been intruded (39%; p < .001). TDIp when the child was 1-year old was associated with SPS (p < .001). Moreover, children who had TDIp had a 4.1 times higher risk of presenting SPS. Conclusions: TDIp is a risk factor for the development of SPS. All types of TDIp caused SPS in this research. Additionally, the younger ages at the time of the injury and intrusions were related to SPS.

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization

Abstract This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

Association Between Presence of Enamel Defects, Dental Caries and Socioeconomic Conditions on Brazilian Children

Objective: To verify the relationship between developmental enamel defects (DED) in permanent incisors and socioeconomic conditions and dental caries in children within the life course context. Material and Methods: A total of 350 children aged 9-11 years from 13 public schools in the city of Bauru, Brazil were examined. Clinical exams were performed to observe the presence of caries and developmental enamel defects using the DMFT and DED indexes, respectively. In addition, information about family income and parental schooling was collected. Statistical analysis used the Spearman Correlation Coefficient and the Chi-square test to verify the association between DED, socioeconomic conditions and dental caries. The significance level adopted was 5%. Results: Association between presence of dental caries and DED (p=0.04), delimited opacity (p=0.02) and opacity (p=0.01) was observed. Inverse correlation for the decayed component with maternal schooling and family income was also verified. Regarding the types of development enamel defect (DED), correlation between delimited opacity, opacity and DED with the DMFT index was observed. Conclusion: The results of this study indicated association between enamel defects and caries, as well as correlation between income and parental schooling and dental caries.

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

OBJECTIVES: We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS: This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS: The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION: The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.