乳牙釉质发育缺陷与儿童早期龋相关研究

釉质发育缺陷是一种临床常见疾病,是由成釉器的损伤引起的牙釉质质量和数量的异常。该疾病在乳牙及恒牙中均可发生,乳牙的釉质发育缺陷常导致儿童早期龋的发生,因此受到更多儿童口腔科医生的关注。本文汇总了近15年有关于乳牙釉质发育缺陷与儿童早期龋相关性内容的中英文文献,从乳牙釉质发育缺陷的诊断、导致儿童早期龋发生的原因、治疗方法以及预防措施等方面进行综述。     

乳牙釉质发育缺陷的患病状况及相关因素分析

目的 了解增城市儿童乳牙釉质发育缺陷（DDE）的患病及分布状况，探讨其可能的致病因素。方法 采用世界卫生组织制定的标准进行临床检查及问卷调查。结果 增城市2－4岁儿童乳牙DDE的患病率为15．5％，主要发生在上颌切牙。母亲在妊娠期患感冒使儿童DDE患病率增加，有显著性差别。结论 母亲在妊娠期患感冒会影响儿童乳牙的釉质发育。     

乳牙釉质发育缺陷临床特点的研究

目的　探讨低出生体重儿和早产儿乳牙釉质发育缺陷的临床特点及其发生机制。方法　选择 1 76名低出生体重儿和早产儿 ,检查乳牙釉质发育缺陷的状况 ,结合出生前、出生时及出生后的病史 ,研究釉质发育缺陷的临床特点及其发生机制。结果　低出生体重儿和早产儿乳牙釉质发育缺陷的患病率为 77 3% ,其患病率男女性别间无显著性差异。乳牙釉质混浊好发于上下第二乳磨牙 ,而乳牙釉质发育不全好发于上下乳切牙和上第一乳磨牙 ,且无论是乳牙釉质混浊还是发育不全 ,基本是对称发生。结论　乳牙釉质发育缺陷主要是由出生时及出生后 1年内全身状况的紊乱所致.     

乳牙釉质发育缺陷的流行病学研究

釉质发育缺陷指牙釉质在发育过程中,硬组织基质形成和矿化受到干扰而导致的缺陷。该疾病可发生于婴幼儿,对婴幼儿乳牙的结构和功能造成影响,长期以来为研究者所关注。该文就近20年来国内外乳牙釉质发育缺陷的流行病学调查情况和其与早期儿童龋病的关系作一综述。     

学龄前儿童乳牙釉质发育缺陷与龋病的关系研究

本研究采用简化的DDE指数,对1074名城乡学龄前儿童进行乳牙釉质发育缺陷和龋齿的现况调查.结果发现农村儿童DDE患病率(19.4%)明显高于城市儿童(8.7%).受检儿童龋齿的患病水平较高,城乡间差异有显著性.研究结果提示:釉质发育缺陷与龋病间有明显的相关性,釉质发育缺陷可以作为评估儿童人群龋病危险性的一个参数.     

早产儿乳牙釉质发育缺陷及患龋状况的临床研究

目的研究早产儿乳牙釉质发育缺陷及龋病的发病率,并探讨两者的相关关系。方法选取3～7岁早产儿及足月出生儿两组各173名,进行乳牙釉质发育缺陷及患龋情况的调查统计和数据对比分析。结果早产儿组釉质发育缺陷(DDE)的患病率(63.58%)明显高于正常出生组DDE的患病率(34.10%),其患病率男女性别间无明显差异。DDE好发于上颌切牙。早产儿组的患龋率(69.36%)与正常出生组的患龋率(71.68%)无明显差异。结论早产儿的乳牙釉质发育缺陷率较高,做好早产儿的口腔保健及父母的口腔健康知识教育是非常重要的。     

Duraphat varnish对乳牙釉质氟含量的影响

目的:检测Duraphat varnish涂布于乳牙后,其釉质内氟元素含量的变化,为临床使用Duraphat varnish预防乳牙龋病提供实验依据。方法:利用电子探针,检测乳牙釉质涂布Duraphat varnish后不同深度的氟含量,并与氟化钠涂布组和生理盐水对照组进行比较;使用X射线光电子能谱仪研究Duraphat varnish涂布剂量及周期变化对乳牙釉质内氟含量的影响。采用SPSS17.0软件包对数据进行统计学分析。结果:对照组、氟化钠组及Duraphat varnish组的氟元素重量百分含量均值分别为(0.0406±0.0234)wt%、(0.1006±0.1040)wt%和(0.1844±0.1293)wt%,Duraphat varnish组氟含量高于氟化钠组,有显著性差异(P<0.01)。Duraphat varnish涂布周期与氟含量关系的实验中,短周期组及长周期组釉质表层下10μm处氟元素重量百分含量均值分别为(0.2407±0.0034)wt%、(0.1434±0.0133)wt%,短周期组氟含量高于长周期组,有显著性差异(P<0.01)。在涂布剂量与氟含量关系的实验中,低剂量组与高剂量组釉质表层下10μm处氟元素重量百分含量均值分别为(0.4417±0.0034)wt%、(0.4413±0.0044)wt%,低剂量组与高剂量组氟含量差别无统计学意义(P>0.05)。结论:乳牙釉质表面局部涂布Duraphat varnish后,釉质中的氟浓度明显升高。缩短该制剂的涂布周期,能有效增加釉质表层内的氟含量,但釉质内氟含量并不随Duraphat varnish涂布剂量增加而升高。     

氟化钠壳聚糖凝胶对乳牙釉质抗酸能力的影响

目的 本实验通过研究氟化钠壳聚糖温敏凝胶对乳牙牙釉质表面抗酸蚀的作用,初步探讨氟化钠壳聚糖温敏凝胶在防治早期龋中的应用可能性。方法 配制氟化钠壳聚糖温敏凝胶,观察其基本性能,使用氟离子选择电极检测壳聚糖氟化钠凝胶氟离子的释放速率。制备乳前牙试件,随机分成4组,分别为多乐氟组、氟化钠壳聚糖凝胶组、壳聚糖空白凝胶处理组和空白对照组,进行乳酸脱钙实验,离子火焰法测试洗脱出的钙离子浓度。SPSS19.0对不同组钙离子浓度进行方差分析,统计结果。结果 壳聚糖氟化钠凝胶,常温下为淡黄色清亮黏稠液体,37 ℃时转变为乳白色的果冻状凝胶。壳聚糖氟化钠凝胶4 h氟离子的释放率为70.22%。氟化钠壳聚糖凝胶处理的乳前牙釉质试件,其脱出的钙离子浓度为4.29 mg/L,低于壳聚糖空白凝胶组(7.20 mg/L)及空白对照组(7.34 mg/L),有统计学差异;但和多乐氟组(4.22 mg/L)没有统计学差异(P>0.05)。结论 氟化钠壳聚糖凝胶可以提高乳前牙的釉质抗酸能力,有应用于预防乳前牙早期龋的可能性。     

两种氟化物对乳牙釉质中氟含量影响的临床研究

目的:测定氟保护漆与氟化泡沫应用前、后乳牙釉质中氟的含量变化.方法:选择30 例患者,以临床同一患者将要拔除的一对下颌乳中切牙为研究对象,随机将患者分为a、b 2 组,a组为:1 颗牙拔除作为对照,另1 颗涂布氟保护漆,24 h后再拔除;b组为:1 颗拔除作为对照,另1 颗涂布氟化泡沫4 min,24 h后拔除.采用中子活化法测定a、b 组每颗牙釉质中氟的含量,进行统计学分析.结果:a 组:实验组氟化物的含量为(142.78±42.25) μg/g,对照组为(119.62±38.62) μg/g.b 组:实验组釉质中氟含量为(162.36±31.36) μg/g,对照组为(126.56±38.42) μg/g;实验组中氟的含量均大于对照组(P<0.05).结论:氟保护漆、氟化泡沫的临床应用均能有效增加牙齿釉质中氟的含量.     

酸蚀时间对乳牙釉质脱矿的影响

目的:采用激光共聚焦显微镜观察不同酸蚀时间对乳牙釉质脱矿的影响,对不同酸蚀时间形成的乳牙釉质的脱矿区进行形态学和数据学评价。方法:采用随机区组设计,将28颗离体下中切牙的唇面分别开4个窗,随机分到酸蚀30s(A)、60s(B)、90s(C)、120s(D)4个处理组中,采用32%磷酸凝胶对标本进行酸蚀处理。0.1mmol/L罗丹明B染色后,进行激光共聚焦显微镜扫描。采用SPSS11.0软件包对数据进行正态性检验和S-N-K法检验。结果:随着酸蚀时间的延长,釉质脱矿条带有所增粗,鱼鳞状结构变得不明显。衡量釉质脱矿程度的3个参数,荧光面积(FLA)、总荧光量(TF)和平均荧光量(AF)的均值随着酸蚀时间的延长而有所增大。A、B、C、D4组的FLA均值分别为(5.5±1.6)×102μm2、(7.4±2.7)×102μm2、(9.2±3.0)×102μm2和(9.6±2.9)×102μm2;4组的TF均值分别为(3.5±1.3)×104、(5.7±2.9)×104、(8.3±3.6)×104和(9.7±3.4)×104;AF均值分别为128.4±35.3、166.6±21.1、200.8±19.4和219.1±12...     

Prevalence of developmental enamel defects in children with cerebral palsy

Enamel defects observed in primary anterior teeth of 123 children with congenital cerebral palsy (CP) born 1983 through 1985 in four northern California counties were categorized using an adaptation of the Developmental Defects of Enamel Index. Nineteen children (15%) had crowns or loss of tooth substance (LTS) due to attrition. Missing enamel (ME) including horizontal groove, was observed in 39 children (32%). Twenty-four children without ME (20%) had enamel pits, vertical grooves, or colored enamel opacities. Forty-one (33%) had clinically normal enamel. ME children did not differ significantly from those with normal enamel with respect to race, sex, singleton vs twin, severity or type of CP, or presence of dysmorphic features. ME children more often had shorter gestational ages than children with normal enamel. More ME children, even those who were not low in birth weight, were reported by parents to have required neonatal intensive care.     

低出生体重儿和早产儿乳牙釉质发育缺陷与龋齿易感性的研究

目的从临床和实验研究两方面探讨乳牙釉质发育缺陷与龋齿易感性的关系。方法选择１７６例３～８岁的低出生体重儿和早产儿，分析乳牙釉质发育缺陷与龋齿的相关性；将４颗自然脱落的釉质发育不全乳前牙用于釉质溶解度的研究，比较发育不全部位和正常部位釉粉的溶解度。结果临床研究发现乳牙釉质发育缺陷与龋齿的发生显著相关；乳牙釉质混浊和釉质发育不全分别与龋齿的发生显著相关。溶解度研究发现发育不全的釉质溶解度大，且达到平衡的时间短。结论釉质发育缺陷（釉质发育不全和釉质混浊）增加了牙齿对龋的易感性     

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

Abstract 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 detect 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). Children with low birth weight also showed a statistically significant higher prevalence of enamel defects (P < 0.05) and a greater severity of hypoplastic lesions measured by EDS (P < 0.05) than those with normal birth weight. The results indicate that nutrition during fetal development is important in determining normal development of enamel in primary teeth. Nutritional status (diagnosed by anthropometric measurements) after the critical period was not associated with enamel defects induced earlier in life. The study suggested, therefore, that nutrition is important for maintaining proper development of the teeth only during the critical period when teeth are susceptible to the formation of defects.     

乳牙釉质混浊的偏光特点及其与龋齿易感性的研究

目的 从临床和实验研究两方面探讨乳牙釉质混浊对龋齿的易感性。方法 选择176名3-8岁的低出生体重儿和早产儿，分析乳牙釉质混浊与龋齿的相关性；将5颗自然脱落的釉质混浊乳前牙用于偏光显微镜的研究，发现其组织学特点，并探讨乳牙釉质混浊的发生机制。结果 临床研究发现乳牙釉质混浊与龋齿的发生显著相关；进一步的偏光显微镜研究的发现乳牙釉质混浊为表层下矿化缺陷，且矿化缺陷区域釉柱横纹加重。结论 乳牙釉质混浊因其表层下矿化缺陷增加了牙齿对龋的易感性，乳牙釉质混浊其发生为在牙齿矿化阶段的第三矿化期的中晚期出现全身或局紊乱所致。     

Prevalence of enamel developmental defects in a group of 11- and 12-year-old children in South Wales

The prevalence of enamel developmental defects was assessed in 579 children aged 11 and 12 yr using the DDE Index. The teeth were dried prior to the examination and a normal dental operating light was used for illumination. Teeth with some type of defective enamel were seen in 48.9% of children. White/single opacities were present in 26.4% of children and white/diffuse, patchy opacities in 9.9% of children. The enamel was abnormal in 5.74% of all teeth with white/single opacities and white/diffuse, patchy opacities occurring in 1.89% and 1.18% of teeth respectively. There was a significantly higher number of teeth affected by enamel defects in boys (P less than 0.01) and boys tended to have a higher prevalence of yellow opacities compared to girls.     

Prenatal and neonatal risk factors for the development of enamel defects in low birth weight children

Oral Diseases (2010) 16 , 257–262 Objective: To analyse the influence of several prenatal and neonatal risk factors in the development of enamel defects in low birth weight children. Subjects and methods: Children between 4 and 5 years of age (n = 102) were classified into: Group 1) 52 low birth weight (<2500 g); Group 2) 50 normal birth weight (≥2500 g). Medical history, prenatal and neonatal variables were collected. Enamel defects were evaluated with the modified Developmental Defects of Enamel Index. Results: The prevalence of hypoplasia and average number of affected teeth were significantly higher in group 1 than in group 2 (59.6%vs 16% and 1.6 vs 0.3 respectively). Low gestational age was linked to a higher prevalence of hypoplastic (P = 0.027) and combined defects (P = 0.001). Children with neonatal risk factors (low Apgar scores, parenteral nutrition, orotracheal intubation, mechanical ventilation and acidosis) developed defects more frequently (P < 0.05). Defects were symmetrically distributed in children who were not intubated; in those who required intubation they concentrated on the left maxillary teeth (P < 0.05). Smoking during pregnancy, young maternal age and multiple birth were significantly associated to developmental defects. Conclusions: The prevalence of enamel defects in primary dentition is significantly influenced by birth weight, gestational age and several systemic factors. Orotracheal intubation probably plays an important role as a result of laryngoscope trauma on the maxilla.     

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children

Objectives

The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil.

Material and Methods

Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis.

Results

75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries.

Conclusions

Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.     

Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia

BACKGROUND: The prevalence of enamel defects in the first permanent molars among children has been reported to be high and may be on the increase, particularly in the European countries. Little information is available on the prevalence of enamel defects in the first permanent molars among children in Australia. The aim of this study was to describe the prevalence of enamel defects in the first permanent molars among school children in Western Australia. METHODS: Informed consent was obtained from parents of children attending pre-primary schools within an administrative area of the School Dental Service of Western Australia in metropolitan Perth to participate in the study in 2005. Parents completed a questionnaire about the mother's health status during pregnancy, and their child's health status for the first three years. Participating children were examined during 2006 and 2007 by one examiner. Teeth were classified on the type and extent of enamel defects using the modified DDE index, and deciduous tooth caries experience of molars and canines was recorded using the WHO criteria. RESULTS: Parents of 634 children out of the eligible 1135 (56 per cent participation) completed the questionnaire. Five hundred and eleven children with at least one erupted first permanent molar were examined (mean age 7.1 years, SD 0.5). Of the first permanent molars, 42 per cent upper right; 37 per cent upper left; 47 per cent lower left; and 45 per cent lower right were without enamel defects. White diffuse opacities were the predominant enamel defects found with 46 per cent upper right; 47 per cent upper left; 40 per cent lower left and 41 per cent lower right molars affected. Demarcated opacities alone or in association with other defects affected 11 per cent upper right; 14 per cent upper left; 10 per cent lower left and 9 per cent lower right molars. At the individual level, 71 per cent had permanent molars with enamel defects; 47 per cent with white diffuse opacities and 22 per cent with demarcated opacities. CONCLUSIONS: Prevalence of enamel defects among this school population is high. Majority of defects were white diffuse opacities and the prevalence of demarcated opacities is at the high end of that reported for some European countries. Possible risk factors for enamel defects remains to be tested.     

Diagnosis of developmental defects of enamel made from photographs

Photographs offer an opportunity to remotely examine teeth for developmental defects of enamel. However, the flash on the camera can cause burn-out which obscures the surface. Therefore, multiple views may be necessary to overcome this problem. In this study we examined the validity and reliability of diagnosis of enamel defects made from photographs. A series of five intra-oral photographs (central, right lateral, left lateral, superior and inferior views) at 1 : 1 magnification were taken for 125 Chinese children aged 12 to 13 years. The maxillary incisor teeth of these children were examined both clinically and photographically for enamel defects which, if present, were recorded using the modified FDI (DDE) Index. One hundred sets of slides were then randomly selected from the subjects and were viewed by six professional and two lay observers for enamel defects. The slide sets of five views and three views (central and two lateral views) were studied separately. The Kappa coefficients which were in the range of “substantial” to “total agreement” (κ = 0.73–1.00) at the tooth level for agreement between the clinical and the five-view photographic assessments on indicated that photographs were a reliable alternative to the clinical examination to detect the presence of enamel defects. No apparent significant differences were noted between the assessments of the two slide sets. These findings suggest that a series of three slides is adequate to study enamel defects for the four maxillary incisors.