Background
The difficulties of caries diagnosis and the level of examiner’s experience may influence the treatment decision, resulting excessive and inefficient intervention.
Aim
This randomized ...experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria.
Design
Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5–12 years, and choose between no treatment, non‐operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers’ consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables.
Results
Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non‐operative treatments for the same lesions.
Conclusions
IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.
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.
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.
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.
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).
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).
Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.
Purpose
To evaluate the feasibility of developing visual diagnostic skills for detecting and assessing dental caries using e‐learning assisted practice in preclinical dental education.
Methods
A ...one‐group before and after the study was conducted. After a theoretical lesson on cariology, 53 inexperienced second‐year preclinical students assessed 78 clinical photographs using the Nyvad criteria; they received automated feedback upon completion of the test. After a week, all students reassessed the same set of photographs, which were randomly reordered. Differential diagnostic accuracy was analyzed category‐pairwise, and overall accuracy measures were based on the receiver operator curve. Diagnostic accuracy in both attempts was evaluated and compared through estimation and pooling of individual student accuracies.
Results
Pooled category‐pairwise accuracy was lower for discriminating Sound surface from Non‐cavitated‐active caries, and for discriminating inactive caries (surface discontinuity) from intact surface inactive caries and Cavitated‐active caries. Pooled overall accuracy, after the theoretical lesson, was 0.79 (95% confidence interval CI 0.77–0.81), and it increased to 0.99 (95% CI 0.98–0.99) after feedback. Between‐student variability in accuracy was reduced from I2 = 0.66 to 0.55.
Conclusion
E‐learning assisted practice is a feasible alternative to start developing visual diagnostic skills for detecting and assessing dental caries using the Nyvad criteria from preclinical dental education in cariology. However, further studies are required to evaluate its effectiveness in improving real‐world practice knowledge and skills.
Abstract Genetic disturbances during dental development influence variation of number and shape of the dentition. In this study, we tested if genetic variation in enamel formation genes is associated ...with molar-incisor hypomineralization (MIH), also taking into consideration caries experience. DNA samples from 163 cases with MIH and 82 unaffected controls from Turkey, and 71 cases with MIH and 89 unaffected controls from Brazil were studied. Eleven markers in five genes ameloblastin ( AMBN ), amelogenin ( AMELX ), enamelin ( ENAM ), tuftelin ( TUFT1 ), and tuftelin-interacting protein 11 ( TFIP11 ) were genotyped by the TaqMan method. Chi-square was used to compare allele and genotype frequencies between cases with MIH and controls. In the Brazilian data, distinct caries experience within the MIH group was also tested for association with genetic variation in enamel formation genes. The ENAM rs3796704 marker was associated with MIH in both populations (Brazil: p = 0.03; OR = 0.28; 95% C.I. = 0.06–1.0; Turkey: p = 1.22e−012; OR = 17.36; 95% C.I. = 5.98–56.78). Associations between TFIP11 ( p = 0.02), ENAM ( p = 0.00001), and AMELX ( p = 0.01) could be seen with caries independent of having MIH or genomic DNA copies of Streptococcus mutans detected by real time PCR in the Brazilian sample. Several genes involved in enamel formation appear to contribute to MIH.
International Journal of Paediatric Dentistry 2010; 20: 426–434
Background. The prevalence of molar incisor hypomineralization (MIH) varies considerably around the world; however, few studies have ...examined MIH in South American countries.
Objective. To evaluate the prevalence, severity, and clinical consequences of MIH in Brazilian children residing in rural and urban areas of the municipality of Botelhos, Minas Gerais, Brazil.
Methods. Children aged 6 to 12 years (n = 918) with all four‐first permanent molars erupted had these teeth evaluated according to the European Academy of Paediatric Dentistry (EAPD) criteria. The examinations were conducted by two previously trained examiners, and the dental impact caused by MIH was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index (WHO).
Results. Molar incisor hypomineralization was present in 19.8% of the 918 children, with a higher prevalence in rural areas. The majority of the defects presented were demarcated opacities without post‐eruptive structural loss, which has been considered as mild defects. Children with MIH had higher DMFT values.
Conclusion. Despite the high prevalence of MIH, the severity of the defects was mild. The results indicate a positive association between MIH and the presence of dental caries.
IntroductionMolar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, ...permanent incisors. The aim of the proposed study is to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) on permanent teeth with MIH through decontamination and sensitivity control.Methods and analysisPatients from 8 to 12 years of age with permanent molars will be randomly allocated to three groups. Group 1: selective chemical–mechanical removal of carious dentinal tissue around the walls of the cavity with Papacárie Duo and a curette followed by the application of aPDT and deproteinisation with Papacárie Duo; group 2: selective removal of carious dentinal tissue around the walls of the cavity with a curette, followed by the application of aPDT and deproteinisation with a 5% sodium hypochlorite solution; group 3: selective removal of carious dentinal tissue using a curette. The selected teeth must have a carious lesion in the dentin and posteruptive enamel breakdown on one or more surfaces with an indication for clinical restorative treatment. The teeth will subsequently be restored using a mixed technique with resin-modified glass ionomer cement and bulk-fill composite resin. The data will be submitted to descriptive statistical analysis. Associations with age and sex will be tested using either the χ2 test or Fisher’s exact test. Pearson’s correlation coefficients will be calculated to determine the strength of correlations between variables. Comparisons of the microbiological results (colony-forming units) will be performed using analysis of variance and the Kruskal-Wallis test. Kaplan-Meier survival analysis will be performed to assess the performance of the restorations.Ethics and disseminationThis protocol has been approved by the Human Research Ethics Committee of Nove de Julho University (certificate number: 61027522.0.0000.5511/approval date: 23 August 2022). The findings will be published in a peer-reviewed journal.Trial registration numberNCT05443035.
Background
The occlusal surface of the first permanent molar is the most frequently affected site by dental caries.
Aim
To assess the caries‐free survival of first permanent molars in children ...participating in a community‐based oral health preventive program.
Design
This was a retrospective study conducted on 426 children under 12 years of age, beneficiaries of a preventive program from 2009 to 2015, in El Cedro, Colombia. The program offered oral health care education, supervised brushing and mouth washing, and application of topical fluoride. By using parametric survival models for interval‐censored data, primary and secondary caries‐free survival of any first permanent molar was estimated and analyzed.
Results
Before program implementation, dental caries lesions presented at an average age, adjusted by age of eruption, of 8.3 years for primary caries lesion and 9.3 years for secondary caries lesion. After 7 years of the program, the estimated average age for presenting primary dental caries lesion was delayed by 4.6 years and by 5.3 years for secondary caries.
Conclusion
The implementation of the oral health program led to improved caries‐free survival of first permanent molars.
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