Kids with developmental defects of the enamel: a longitudinal study
Teeth with developmental defects of the enamel (DDE) present a much higher risk of developing caries and develop caries earlier than teeth without DDE. DDE are also a strong determinant for caries in the primary dentition.
Those 2 findings are from a study published in the October 2016 issue of JDR Clinical & Translational Research.
The goal of the study was to track all teeth in the primary dentition of a large group of Australian children from birth to age 6 years and to record DDE status to measure the susceptibility to caries. Researchers tracked 14,220 primary teeth in 725 children and conducted interviews by phone or during at-home visits at 6-month intervals. Seventy-four children (10.2%) had at least 1 tooth with DDE. Researchers examined all of the children at the community dental clinic at 24, 36, 48, 60, 66, and 72 months.
They examined the surface of each tooth and separately recorded DDE and caries. They recorded enamel defects using a modified DDE index and grouped them into categories: enamel pits, missing enamel, hypoplasia occurring with demarcated white or yellow-brown opacities (hypomineralization), and opacities occurring without enamel hypoplasia. Clinical examinations included bitewing radiographs at ages 5 and 6 years. Researchers recorded a proximal surface as being carious if the bitewing radiograph showed that the lesion had progressed beyond the dentinoenamel junction and involved dentin. Teeth were numbered according to the FDI World Dental Federation notation in which central incisors were teeth nos. 51, 61, 71, and 81 and second molars were teeth nos. 55, 65, 75, and 85.
In the 74 children with DDE, the mean (standard deviation) number of DDE teeth per child was 1.76 (1.0). There were no differences in gestational age, birth weight, or sex between those with and without DDE, but there was a significant difference in the number of children with caries; 57% of those with DDE and 28% of those without DDE. The highest odds ratios (likelihood) for DDE were noted in the primary second molars: 7.30, 6.41, 6.24, and 5.42 in teeth nos. 75, 85, 65, and 55, respectively. Increased likelihood were also noted in 3 of the primary first molars: teeth nos. 74, 84, and 64. The highest likelihood for caries were also noted in the second molars: 6.16, 5.83, 5.82, and 4.97 in teeth nos. 85, 55, 65, and 75, respectively. Every examination between years 2 and 6 showed a higher prevalence of caries in teeth with DDE than teeth without DDE. The proportion of teeth with caries increased more rapidly over time in teeth with DDE than in teeth without DDE. Teeth with DDE were at much higher risk of developing caries, with the pit type of defect seeming to be the most susceptible.
“The present results clearly show that DDE are major predisposing factors for caries, even in low-risk children,” the authors concluded. “This new longitudinal evidence supports and extends the results of our previous case control investigation and other studies of children at high risk of caries.”
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Consulting Editor: Paul S. Casamassimo, DDS, MS
Professor of Pediatric Dentistry, The Ohio State University College of Dentistry and Nationwide Children's Hospital, Columbus, OH
Consulting Editor: Arthur J. Nowak, DMD
Professor Emeritus, University of Iowa College of Dentistry Affiliate Professor, University of Washington School of Dentistry
Fluoride varnish and children’s esthetic perceptions of permanent incisors
Fluoride varnish applications in preschoolers are not associated with any level of fluorosis in their permanent maxillary incisors, and the fluorosis does not influence children’s esthetic perception of their teeth.
These findings are from research published in the September/October 2016 issue of Pediatric Dentistry.
Researchers designed the study with a 2-fold purpose: to compare the prevalence and severity of dental fluorosis in the permanent maxillary incisors of children 4 years after a 2-year clinical trial on biannual fluoride varnish application in the primary dentition, and to measure children’s esthetic perception of their teeth.
The authors randomly allocated 200 1- to 4-year-olds to either a test group (biannual fluoride varnish application) or a control group (biannual placebo varnish application) and followed them for 2 years. The parents were contacted by phone or mail 4 years after the end of the clinical trial to make an appointment. Two calibrated examiners assessed dental fluorosis using the Thylstrup and Fejerskov (TF) index and interviewed the children regarding their perceptions of teeth appearance.
They examined all of the children in a dental office using a dental mirror, under natural light, after supervised tooth brushing. The buccal surfaces of the permanent maxillary incisors were classified for fluorosis after being dried with cotton rolls. Once fluorosis was diagnosed, the child received scores for the 2 most severely affected teeth.
Two key perception questions focused on distress (“During the past two months, how upset have you been about the way your teeth look?”) and about social concern (“During the past two months, how much has the way your teeth look kept you from smiling freely?”) A third question asked about the children’s self-perceived teeth discoloration (“Please rate your teeth according to the following: very white; white; not white or stained; slightly stained; and very stained”). A fourth question asked children for their opinions using a statement on how pleasant their teeth color was (“The color of my teeth is pleasing and looks nice”).
A total of 123 (61.5%) children were re-examined; 63 originally were in the test group, and 60 were in the control group.
A total of 38 children (30.9%) had some form of dental fluorosis. The most frequent scores were TF index 2 (18 children) and TF index 1 (12 children). A TF index score of 3 was found in 7 children, and TF index score of 5 was found in 1 child. When only the cases of esthetically objectionable fluorosis were considered (TF index score equaled at least 3), the prevalence of fluorosis decreased to 6.5%. There was no statistically significant difference between fluorosis in the permanent maxillary incisors among the children who had received biannual fluoride varnish applications and those who had received biannual placebo varnish applications. Children’s responses regarding the esthetic perceptions of their teeth showed no statistically significant difference between children with and without fluorosis.
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Risk factor links to caries stages in children
Maternal socioeconomic indicators and children’s behaviors are related to changes from caries-free status to different caries stages. Socioeconomic indicators and casual factors act in synergy, and as the lesion progresses, diet becomes more important in the process.
These findings are from a study published online December 1, 2016 in BMC Public Health.
Researchers developed a cross-sectional survey to see if certain risk factors would affect different stages of the caries disease process. They randomly selected 390 children aged 6 through 8 years. Researchers assessed caries and grouped the participants as follows: highest caries score, most prevalent caries score, and number of affected teeth. They grouped data from clinical examinations as follows: no caries, initial stage, moderate stage, and extensive stage. They grouped the number of affected teeth as follows: 1 or 2 affected teeth, 3 through 5 affected teeth, and 6 or more affected teeth. Parents or guardians completed a questionnaire regarding vital statistics, socioeconomic indicators, dietary habits, oral hygiene habits, and oral health behaviors.
Carious lesions were detected in 42.3% of the participants, while the caries experience (sum of decayed, filled, and missing teeth due to caries) was 44.1%. The researchers divided affected children into the following categories: 2.56% at initial stage, 13.33% at moderate stage, and 26.42% at extensive stage. According to the most prevalent carious lesion stage, the researchers divided the affected children into the following categories: 4.10% with a prevalence of initial stage, 14.36% with a prevalence of moderate stage, and the remaining 23.85% with a prevalence of extensive stage. According to the number of affected teeth, the researchers divided the children into the following categories: 18.21% with 1 or 2 affected teeth, 13.33% with 3 through 5 affected teeth, and 10.77% with 6 or more affected teeth.
The most severe caries stage was statistically associated with a non–European Union maternal birthplace, the educational levels of both parents, and with the use of a sweetened pacifier at night, the use of lactose-free milk, and the frequency of tooth brushing. The distribution of affected children showed statistically significant associations with parents’ educational levels, with the occupational status of the mother, and with the use of a sweetened pacifier at night. The researchers found no statistically significant associations between the stratification number of affected teeth and background variables.
In the multinomial model, the base outcome was the participants with prevalence of the highest caries stage; in children with a majority of initial lesions, being male, and the unemployment status of the father were embodied in this stage. In participants with a prevalence of moderate lesions, a low educational level of the mother, paternal unemployment status, and use of a sweetened pacifier at night were the distinguishing factors.
Changes in caries status and progression were dependent on maternal nationality and education levels, paternal unemployment, intake of lactose-free milk, tooth brushing frequency and use of sweetened pacifiers.
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Tooth brushing frequency and caries incidence
People who brush their teeth less often are at greater risk of the increased incidence and increment of new carious lesions than those brushing more often. The effect is more pronounced in the primary dentition than in the permanent dentition.
These findings are from a study published in the November 2016 issue of Journal of Dental Research. The study’s authors conducted a systematic review and meta-analysis to measure the effect of tooth brushing frequency on the incidence and increment of carious lesions.
They conducted a systematic search of the literature in January 2016 in 4 electronic databases: MEDLINE via PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane. They retrieved 5,494 titles but only 33 were eligible for inclusion. For quantitative synthesis, data could only be extracted and used from 25 articles. The researchers collected data on study setting, study design, sample size, follow-up period, dental caries outcome and diagnostic criteria, categories used to record the frequency of tooth brushing, absolute values necessary for meta-analysis, findings, and information on other sources of fluoride.
For meta-regression analysis, the researchers obtained data on each confounding variable from all 25 studies included in the meta-analysis. Three different meta-analyses were conducted: 2 based on the caries outcome reported in the studies (incidence and increment) with subgroup analyses of categories of tooth brushing frequency and the other included all studies irrespective of the caries outcome reported with the type of dentition as subgroups.
Infrequent tooth brushers showed a higher incidence of carious lesions. The odds of having carious lesions differed little when the researchers conducted a subgroup analysis to compare the incidence between at least twice per day with less than twice per day and at least once per day with less than once per day brushers. Brushing less than twice per day significantly caused an increased increment of carious lesions compared with brushing at least twice a day. There were no differences between at least twice a day brushing and less than twice a day brushing for an increment of carious lesions. When the researchers conducted a meta-analysis using the type of dentition as a subgroup, there was an increased chance of incidence or increment of carious lesions among infrequent brushers than those brushing frequently in both the primary and permanent dentitions. This association was greater in the primary dentition than in the permanent dentition.
The study limitations included a marked variation in the way tooth brushing frequency was reported, that data on the effectiveness of tooth brushing frequency adjusted for exposure to fluoride dentifrice were not provided, and that the search was restricted to studies published only in English after 1980.
“More longitudinal studies from developing and low-income countries might be helpful in assessing the independent effect of tooth brushing frequency on dental caries as it is easier to identify populations not using fluoridated products in some of these countries,” the authors concluded. “Furthermore, it would be helpful for future research if studies can use a uniform protocol for reporting tooth brushing frequency, which could be one of the constituents of a core outcome set for tooth brushing studies.”
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