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Hearing and neurologic impairment: insult timing indicated by primary tooth enamel defects.

The association between hearing loss, neurologic impairment, and primary tooth enamel defects was examined in a group of 88 children presenting for hearing evaluation at a tertiary care children's hospital. Forty-one had classifiable enamel defects, reflecting the time and duration of prenatal or perinatal insult. Hearing loss was more prevalent and severe in 19 children with enamel defects of the incisal tooth edge (mean = 61 dB) reflecting a systemic insult at 14 to 16 weeks gestation, than in 7 children with cervical third tooth defects (mean = 23 dB) reflecting insult near term (X2 = 4.08; p less than 0.05). Audiometric findings among the 15 children with incisor defects of the middle third varied; 7 had significant hearing loss and 8 were normal. A correlation was observed between severity of hearing loss (in dB) and estimated time of systemic insult (in weeks gestational age) determined by tooth defect site (r = -0.48; p less than 0.01). The neurologic data revealed similar trends. The group with early systemic insults more frequently had moderate or severe neurologic deficits known to originate early in fetal development. The two groups with third trimester or term insults tended to have mild or no neurologic impairment. A differential susceptibility for developing auditory and neurologic structures based on insult timing is supported.

Audiometry↗

[Evaluation of the dental eruption pattern and of enamel defects in the premature child].

BACKGROUND: The purpose of this study was to analyze the relation between enamel defects and delay of dental eruption with prematurity. METHODS: the sample consisted of 100 premature children ranging from six months to six years of age, observed in the Children Institute of the Medical School of the USP. An anamnesis of the oral cavity was carried out by just one observer who analyzed the chronology of teeth eruption as well as the occurrence of enamel defects. A medical evaluation was also conducted in order to detect potential problems during the prenatal, neonatal and postnatal periods. The statistical assessment included descriptive analysis, average frequency and a confidence interval of 95%. RESULTS: Defects appeared in 35% of the premature children; 51.43% of those affected had been born with a low weight (< 2500g), compared to 14.29% born with normal weight (> 2500g). No relationship was found between the occurrence of defects with a low Apgar score during the first minute, second minute and five minutes (p=0.628; p=0.308;p=0.,193). The most common defects were white opacities, in the deciduous (19.0%) as well as in the permanent dentition (100%). The incisor and cervical halves of the vestibular faces were the most affected reaching values of 88.04% for the deciduous dentition and of 100% for the permanent one. In about 42% of children eruption of teeth took place between 6 to 10 months of age. CONCLUSIONS: Premature children may have enamel defects caused by different factors that appear during pregnancy with a possible association between low weight and enamel defects. Furthermore, premature children had teeth eruption in a normal period, nevertheless, until 36 months of age with less teeth total than children born at normal term.

Apgar Score↗

[Prevalence of enamel defects and the relationship to dental caries in deciduous and permanent dentition in Indaiatuba, São Paulo, Brazil].

The aim of this study was to determine the prevalence of hypoplasia, demarcated opacity and dental fluorosis among schoolchildren with deciduous and permanent dentition. The association between enamel defects and dental caries was also verified. The sample consisted of 624 schoolchildren aged 5 and 309 aged 12. The dmft and DMFT indexes were used to assess dental caries prevalence, DDE to assess enamel defects, and Dean to assess fluorosis. Chi-squared test was used to test significance (p < 0.05) and odds ratio to analyze prevalence of dental caries and enamel defects. A positive association between dental caries and enamel defects (hypoplasia, demarcated opacity and dental fluorosis) was observed for schoolchildren aged 5. However, only hypoplasia and demarcated opacity were associated with caries experience in permanent dentition. The results of this study indicated that children had increased odds of dental caries when enamel defect was present, both in deciduous and permanent dentition; further studies are needed to give evidence to this association.

Brazil↗

The prevalence of caries and enamel defects in 229 Malaysian children 16 years after water fluoridation (a pilot study).

Two hundred and twenty-nine children aged 12-15 years who were continuous residents of Penang island, in the north of Peninsular Malaysia were examined for caries and enamel defects. Caries prevalence was 82.2% with a DMFT score of 3.4 and DMFS score of 4.9; there were very few missing teeth and very little untreated caries in the population examined. Majority of DF (decayed/filled) lesions were pits and fissures with approximal and smooth surfaces relatively caries free. The prevalence of enamel defects was 76.4% with 19.1% of all teeth examined being affected. More posterior than anterior teeth were affected by enamel defects just as there were more maxillary than mandibular teeth affected by enamel defects. Diffuse patchy opacities were the most common defect diagnosed and this was found in 60.2% of the population examined. A bilateral distribution of diffuse patchy opacities was seen in 41.5% of the population examined. Tooth surfaces with enamel defects were no more susceptible to caries than defect-free surfaces.

Adolescent↗

Association of amoxicillin use during early childhood with developmental tooth enamel defects.

BACKGROUND: It has been speculated that amoxicillin use could be associated with dental enamel defects. OBJECTIVE: To assess the association between dental fluorosis, one of the most common developmental tooth enamel defects, and amoxicillin use during early childhood. DESIGN, SETTING, AND PARTICIPANTS: As participants in the Iowa Fluoride Study, subjects were followed up from birth to 32 months using questionnaires every 3 to 4 months to gather information on fluoride intake and amoxicillin use. METHODS: Early-erupting permanent teeth of 579 subjects were assessed for fluorosis using the Fluorosis Risk Index at approximately the age of 9 years. Relationships between fluorosis and amoxicillin use were assessed using relative risk (RR), Mantel-Haenszel stratified analyses, and multivariable logistic regression. RESULTS: Amoxicillin use was reported by 75% of subjects by 12 months and 91% by 32 months. Overall, 24% had fluorosis on both maxillary central incisors. Amoxicillin use from 3 to 6 months significantly increased the risk of fluorosis on the maxillary central incisors (RR = 2.04; 95% confidence interval [CI], 1.49-2.78). After adjusting for fluoride intake and otitis media, the risk of fluorosis on the maxillary central incisors from amoxicillin use during 3 to 6 months (Mantel-Haenszel RR = 1.85; 95% CI, 1.20-2.78) was still statistically significant. Multivariable logistic regression analyses confirmed the increased risk of fluorosis from amoxicillin use during 3 to 6 months (odds ratio = 2.50; 95% CI, 1.21-5.15); fluoride intake was also statistically significant. CONCLUSION: The findings from this study suggest a link between amoxicillin use during infancy and developmental enamel defects of permanent teeth; however, further research is needed.

Amoxicillin↗

Coeliac-type dental enamel defects in patients with dermatitis herpetiformis.

The teeth of 30 adult patients with dermatitis herpetiformis and 66 sex- and age-matched healthy controls were examined for dental enamel defects. Sixteen of the patients (53%) with dermatitis herpetiformis, opposed to only one (2%) of the healthy controls (p less than 0.001), were found to have coeliactype permanent-tooth enamel defects. The grades of these defects were milder than those described for severe coeliac disease. There was no correlation between the degree of enamel defects and jejunal villous atrophy. The present finding of frequent coeliactype dental enamel defects in adults with dermatitis herpetiformis suggests that these patients were already suffering from subclinical gluteninduced enteropathy in early childhood, at the time when the crowns of permanent teeth develop.

Adult↗

Aetiology of developmental enamel defects not related to fluorosis.

The aetiological factors in enamel defects of a non-fluoride nature can be divided into systemic and local. The systemic factors comprise a variety of conditions: genetically determined, chromosomal anomalies, congenital defects, inborn errors of metabolism, neonatal disturbances, infectious diseases, neurological disturbances, endocrinopathies, nutritional deficiencies, nephropathies, enteropathies, liver diseases and intoxications. The genetically determined enamel defects include amelogenesis imperfecta, which may occur as an isolated phenomenon or as part of other disorders such as epidermolysis bullosa, pseudohypoparathyroidism and taurodontism. The congenital defects include heart disorders and unilateral facial hypoplasia and hypertrophy. Among the inborn errors of metabolism are: galactosaemia, phenylketonuria, alkaptonuria, erythropoietic porphyria and primary hyperoxaluria. Neonatal disturbances are important in the development of enamel hypoplasia, foremost among these are premature birth and hypocalcaemia. The latter causes postnatal hypoplasias, which, however, are never seen in breast-fed children. Haemolytic anaemia, mostly in conjunction with erythroblastosis foetalis, may cause enamel hypoplasia. In children with neurological disturbances a rather large number have enamel hypoplasias, and these changes may be a significant aid in neurological diagnosis. When the tetracyclines were introduced, many children had these drugs prescribed in the period when the teeth were undergoing mineralization. The result was a yellow-brown stain of the affected teeth. In recent years, however, there appears to have been a reduction in the incidence of tetracycline staining. As for local causes the most important are traumatic injuries and periapical osteitis of primary teeth.

Amelogenesis Imperfecta↗

[Studies on developmental enamel defects in the primary dentition of children with histories of low birth weight and prematurity and their susceptibility to dental caries].

OBJECTIVE: From the clinical and experimental aspects, to study the susceptibility of dental enamel defects to dental caries in the primary dentition. METHODS: One hundred and seventy-six children (aged 3-8) with histories of low birth weight and premature birth were studied about the relationship of dental enamel defect to caries. Four exfoliated hypoplastic anterior deciduous teeth were studied about the solubility of dental enamel in order to compare the solubility of the defective enamel with that of the normal enamel in the same teeth. RESULTS: The prevalence of both enamel opacity and enamel hypoplasia was significantly interrelated to prevalence of dental caries in those particular teeth. The solubility of the hypoplastic enamel powder was higher than that of the normal enamel in the same teeth. It took shorter time for the hypoplastic enamel powder to attain an equilibrium than the normal did. CONCLUSION: The defective enamel was much easier attacked by caries.

Birth Weight↗

The association between developmental enamel defects and caries in populations with and without fluoride in their drinking water.

OBJECTIVES: The purpose of this study was to consider the association between developmental enamel defects and dental caries in children from areas with different levels of fluoride in their drinking water. METHODS: children (mean age = 14.1 +/- 0.3 years) were examined from areas with less than 0.1 ppm (n = 267) and 0.7 ppm (n = 196) in their drinking water. These areas were chosen to contain subjects with a similar social profile. Two types of enamel defect were considered: those consistent with the diagnostic criteria of the Thylstrup Fejerskov (TF) index and demarcated opacities. Dental caries was recorded for surfaces at the level of the dentinal lesion. RESULTS: Subjects with one or more demarcated opacities had more dental caries than those without these opacities present. Children with enamel defects scored with the TF index tended to have less dental caries than those without these defects present. However, the difference was only statistically significant in the area without fluoride in the drinking water. CONCLUSIONS: Developmental enamel defects may be useful markers of caries susceptibility, which should be considered in the risk-benefit assessment for use of fluoride. Further studies are required to clarify the relationship between developmental enamel opacities and dental caries and the reasons for any associations.

Adolescent↗

[Enamel defects in tuberous sclerosis: hard facts of diagnostic importance].

Tuberous sclerosis is a complex syndrome. Recognition of the disease can be very difficult because of its incomplete forms. In this article a new symptom of possibly great diagnostic value is discussed, namely the presence of enamel defects in patients with tuberous sclerosis. For a clear understanding and correct interpretation of enamel defects in general, the role of the odontogenesis, the amelogenesis and the different types of developmental disturbances is explained. A review is given of all published investigations concerning the presence of enamel defects in tuberous sclerosis. The conclusion is that the enamel defects may be of great importance for an early diagnosis as well as for a possible revise of the penetrance and mutation rate of the disease.

Amelogenesis↗

Breast-feeding and other mother-child factors associated with developmental enamel defects in the primary teeth of Brazilian children.

PURPOSE: The purpose of this study was to examine the association between developmental defects in the enamel (DDE) of the primary teeth and low birth weight or prematurity. METHODS: A case-control study was carried out in Itajaí, Southern Brazil, involving 3- to 5-year-old children. The case group was composed of 102 children presenting at least 1 dental surface with DDE. The control group comprised 113 children without DDE matched by sex and age and enrolled in the same day care centers. All teeth were clinically examined using the Modified Index of Developmental Defects of Enamel. The outcome variable of the study was DDE in at least 1 dental surface, and the independent variables were: (1) birth weight; (2) gestational age; and (3) breast-feeding. Maternal schooling and health problems of the mother during pregnancy and of the child during the first year of life were collected as potential confounding factors. Simple and conditional multiple logistic regression analyses were performed, providing crude and adjusted odds ratio and 95% confidence intervals. RESULTS: Prematurity (OR=2.6; 95% CI=1.0-6.4) and children who did not breast-feed (OR=3.2; 95% CI=1.2-8.4) were associated with defects in tooth enamel after adjusting for possible confounding variables. CONCLUSIONS: In this study, premature children and those who did not breast-feed could be considered at risk for developing defects in tooth enamel.

Adolescent↗

Prevalence of fluorosis and other enamel defects related to caries among adults in communities with optimal and low water fluoride concentrations.

The aim of this Swedish study, performed in 1982, was to determine the prevalence of fluorotic and nonfluorotic enamel defects among adults in areas with optimal and low fluoride concentrations in water. The fluorosis prevalence was also related to caries prevalence in these areas. The study was based on clinical examinations of subjects born between 1939-1951 who had been drinking water with a fluoride content representative of their area of residence all their lives. This water was the only appreciable source of fluoride during tooth formation. Two hundred and sixty individuals living in the optimal fluoride area were included in the study and 236 individuals from the low fluoride area. The results showed first, a low prevalence of mild dental fluorosis in the area with optimal fluoride content in its drinking water; secondly, a low prevalence of non-fluorotic enamel defects, which was, however, higher in the low fluoride area than in the optimal fluoride area; thirdly, that caries prevalence was lower among those with fluorotic enamel defects in the optimal fluoride area; and lastly, caries prevalence was not influenced by non-fluorotic enamel defects.

Adult↗

Developmental enamel defects in children with different fluoride supplementation--a follow-up study.

The intake of fluorides with water, food, dental fluoride preparations, or in particular fluoride supplements, such as NaF tablets, may lead to dental fluorosis. In the present study conducted in a nonfluoridated area in Germany, developmental enamel defects were examined using the Modified Developmental Defects of Enamel Index (Mod DDE Index), which subdivides enamel defects into the categories demarcated (Mod DDE score 1) and diffuse (Mod DDE score 2) opacities and hypoplasia (Mod DDE score 3). 158 children, between 8.5 and 10 years old, were assigned to three examination groups, defined by three different fluoride tablet programs. The children in all three examination groups, F1, F2, and F3, had received 0.25 mg F-/day up to the age of 2 years, F1 and F3 from birth on, F2 beginning with the 7th month of life. F1 and F2 received 0.5 mg F-/day during the 3rd and 0.75 mg F-/day during the 4th and 5th year of life. For F3, beginning with the 3rd year of life, no further recommendations were made. 158 sociodemographically matched children living in a neighboring town served as controls and did not take part in any structured fluoride supplementation program. The proportions of children with Mod DDE scores 1, 2, or 3 at least in one index tooth were significantly higher in the examination groups (40%) than in the control group (20%). Also, the proportions of children with Mod DDE score 2 at least in one index tooth were significantly higher in the examination groups (18%) than in the control group (8%). The proportions of children with Mod DDE score 1 at least in one index tooth were 25% in the examination groups and 17% in the control group. No Mod DDE score 3 was found. Not more than 5% of the children in each group had 50% of their teeth with Mod DDE score 1, 2, or 3. The proportions of teeth per child with Mod DDE score 2 were significantly higher in the examination group than in the control group. While uncontrolled variables cannot be excluded, the observed differences between the experimental and control groups may be attributed to the ingestion of fluoride tablets in the experimental group.

Age Factors↗

Interproximal contact hypoplasia in primary teeth: A new enamel defect with anthropological and clinical relevance.

This study reports the prevalence, distribution, and expression of enamel defects in a sample of primary teeth (n = 225) from a prehistoric site in western India (1400-700 BC). Five enamel surfaces of individual, isolated primary teeth were observed for surface defects using a binocular stereomicroscope with variable power of magnification (8-20x). Standards for evaluating dental enamel defects (DDE) recommended by the Fédération Dentaire International (FDI) were employed. Details of defect expression were also recorded, including size, shape, and surface of tooth crown affected. Hypoplastic enamel defects were observed in 28% of teeth, but the distribution and expression of defects was not random. More than 50% of canine teeth had hypoplastic defects (HD); incisors and molar teeth exhibited far fewer HD. The buccal surface of canines was the most commonly affected crown surface. Areas of missing enamel were also common on the mesial and distal surfaces of canines and incisors and on the mesial surface of molar teeth. The high frequency of enamel defects found on interproximal crown surfaces warrants a label, and the name interproximal contact hypoplasia (IPCH) is proposed. Linear enamel hypoplasia (LEH) was absent from this primary dental sample. IPCH is more frequent in mandibular than in maxillary teeth, but no side preference was detected. In canine teeth, buccal hypoplasias (localized hypoplasia of primary canines; LHPC) were not positively correlated with interproximal hypoplastic defects. The etiology of IPCH may involve mesial compaction of developing teeth due to slow longitudinal growth of the jaws. Episodic bone remodeling results in ephemeral fenestrae in the mesial and distal walls of the dental crypt permitting tooth-tooth contact and disruption of amelogenesis. IPCH prevalence decreases across the subsistence transition from sedentary Early Jorwe agriculturalists to seminomadic Late Jorwe hunters and foragers, but the difference is not statistically significant. This may be due to underrepresentation of mandibular teeth in the sample. Am. J. Hum. Biol. 11:718-734, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗

Prevalence of dental enamel defects in 6, 7 and 8-year-old children resident in West Bromwich, Sandwell, UK.

Prompted by a parent's concern about the enamel defects of his daughter's teeth, the present study surveyed a sample of 6-8-year-old children using a modified developmental defects of enamel index. The aim was to establish the prevalence of such defects in permanent teeth of children in West Bromwich and to investigate differences according to social class or ethnic origin. Results showed that the mouth and tooth prevalence of enamel defects in Sandwell were not higher than those reported in similar studies. Analysis revealed no statistical significance between the tooth or mouth prevalence of defects according to the social class of the child although significant differences were found between children of Asian and non-Asian origin. A greater prevalence of diffuse defects was found among non-Asian children, conversely there was a greater prevalence of demarcated defects among Asian children. Recommendations are made in relation to the conduct of future studies of a similar kind with regard to the number of teeth examined, the presentation of reproducibility results and the evaluation of the cosmetic appearance of the teeth.

Asia↗

Enamel defects in the deciduous dentition as a potential predictor of defects in the permanent dentition of 8- and 9-year-old children in fluoridated Cheshire, England.

It is claimed that dental fluorosis in both deciduous and permanent teeth is increasing in fluoridated and non-fluoridated communities. What is unclear is whether fluoride-induced enamel opacities in the deciduous dentition are associated with the subsequent appearance of enamel defects in the permanent dentition. The aim of this study was to establish whether a relationship existed between the presence of diffuse enamel defects on the deciduous molars and permanent incisors of schoolchildren who were lifetime residents in an optimally fluoridated community in Cheshire, England. The dentitions of eight-and nine-year-old children were examined by two examiners, each unaware of the findings of the other. There was a significant increased risk of diffuse enamel defects in the permanent incisors for those children who presented with diffuse defects on their first deciduous molars (Relative Risk, 1.45; 95% confidence interval, 1.05 to 2.0) or second deciduous molars (Relative Risk, 1.86; 95% confidence interval, 1.36 to 2.54). In light of these findings, it is worth considering the potential of the presence of enamel defects in deciduous molars in children aged 1 to 3 years as a predictor of the future appearance of similar lesions in their permanent incisors.

Case-Control Studies↗

Prevalence and distribution of developmental enamel defects in primary dentition of Chinese children 3-5 years old.

A total of 1344 children, 3-5 yr old, from two rural counties, Haidian and Miyun, close to Beijing, China, were examined in 1992. A modified DDE Index was employed in this study, and a pre-designed formula was used to calculate an enamel defect score (EDS) for each individual in the study. Oral examination was performed by one dentist under natural light using a standard mouth mirror and dental probe. Developmental enamel lesions were diagnosed without drying or cleaning the teeth prior to examination. Results from this study showed that primary teeth with defective enamel were seen in 23.9% of the children examined, opacity in 1.6%, and hypoplasia in 22.2%. Among the teeth, maxillary central and lateral incisors were affected by enamel hypoplasia most often (40.8% and 39.2%), followed by maxillary canines (25.7%), maxillary 1st molars (22.1%), and mandibular 1st molars (18.5%). The enamel defects occurred more frequently on the buccal surfaces of teeth than on any other surface. The study did not find a significant association of the children's age, family socioeconomic status, and anthropometric measurements with the distribution of enamel defects. However, there was a significantly higher prevalence of teeth with defects in males compared to females (P < 0.001), as well as mean tooth surfaces with defects (P < 0.05), and mean EDS (P < 0.05). Children born prematurely were shown to have four times more enamel lesions than children who were full term (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

Enamel defects in permanent maxillary incisors of Singaporean children.

Defects in development of enamel may occur as a result of a multiplicity of factors. The effect on aesthetics is of significance to the practising dental surgeon. In this connection, the prevalence and distribution of enamel defects in the permanent maxillary incisor teeth was assessed in a group of primary school children resident in Singapore from birth. The results are compared with findings from studies on communities in different countries and with varying levels of fluoride in the water supply.

Adolescent↗