Influence of socio-economic conditions on dental development in Nigerian children

A joint dental, biochemical and nutritional study was carried out on Nigerian children from different socio-economic backgrounds. Timing of eruption of deciduous dentition and prevalence of enamel hypoplasia were recorded. Evaluation of findings in 872 children from the Yoruba community of Western Nigeria showed that physical development, as reflected in heights and body weights, was retarded in the underprivileged, malnourished village children compared with their counterparts from higher socio-economic homes. Eruption of the deciduous teeth demonstrated good correlation with changes in height and weight. Enamel hypoplasia was not seen in any of the well-fed children examined. In contrast, among 420 village children aged 0–4 yr, the prevalence of gross enamel hypoplasia of the deciduous teeth was 21 per cent. Hypoplastic defects of enamel involving the pre-natally formed parts of the deciduous dentition accounted for 72 per cent of the observed cases. No evidence emerged of a causal relationship between the enamel hypoplasia and past or present systemic conditions, including premature birth. The developing dental organ, like most other organs of the body, appears to be susceptible to factors associated with low socioeconomic status. Prominent among such factors in developing countries is severe malnutrition.     

Etiological factors influencing the prevalence of developmental defects of dental enamel in nine-year-old New Zealand children participating in a health and development study

Over 1000 children, participating in a longitudinal study of health and development, possess documented medical histories based on birth records and regular assessments starting at age 3. A dental examination at age 5 of 923 participants recorded their exposure to fluoride and evidence of trauma to the deciduous teeth. The prevalence of developmental defects of dental enamel in 696 of the children when aged 9 was reported as 56% (Suckling et al., 1985). For the present study, a number of illnesses, accidents, and other experiences were selected from the recorded information as possible etiological factors for any defect, demarcated and diffuse opacities, and hypoplasia. Despite extensive statistical testing, positive and strong associations were few. The prevalence of hypoplasia, seen in 15% of the sample, was higher in those children who had chicken pox before age 3 and, as reported previously, in those children with a history of trauma to their deciduous incisors. This study illustrates the difficulty of establishing the etiology of enamel defects, even when medical and dental histories are available.     

Classification and prevalence of enamel opacities in the human deciduous and permanent dentitions

A reproducible classification of enamel opacities which is generally applicable for use in clinical investigations was used to determine the prevalence of defects in both deciduous and permanent dentitions in low-fluoride areas; 303 children aged 6 yr and 1214 children aged 13–14 yr were examined. Almost one third of them had enamel opacities in the deciduous dentition, and over 80 per cent showed defects in the permanent dentition. Horizontal white lines in the enamel of permanent teeth, stated to be pathognomic of fluoride-induced enamel changes, were found in 29 children (2.4 per cent). All the children had lived in areas where the drinking water contained less than 0.26 parts/10⁶ fluoride, and none had received fluoride supplementation. The classification used was not based on a presumed aetiology of enamel opacities and could therefore be used to compare prevalence in fluoride-supplemented and low-fluoride areas.     

PRENATAL AND NEONATAL VARIABLES ASSOCIATED WITH ENAMEL HYPOPLASIA IN DECIDUOUS TEETH IN LOW BIRTH WEIGHT PRETERM INFANTS

This study investigated possible prenatal and neonatal variables that may influence the prevalence of tooth enamel hypoplasia in preterm and low birth weight children (LBW) and a matched control group of term children with normal birth weight (NBW). The study sample consisted of 61 children born preterm and with LBW examined at 18-34 months of age. The control group was formed by 61 infants born full term and with NBW examined at 31-35 months of age. All children were born at the Center of Integrated Attention of Women''s Health (CAISM-UNICAMP). FDI criteria were followed for dental examination. Medical data was collected retrospectively from hospital records. Among preterms, 57.4% had some type of developmental defects of enamel (DDE), 52.5 % had opacities and 21.3 % presented hypoplasia. Among full-term children, 24.6% presented DDE, 24.6% had opacities and 3.3% had hypoplasia. LBW preterm infants presented a higher prevalence of hypoplasia than NBW controls. The deciduous teeth most affected by hypoplasia were maxillary incisors. There was no significant association with prenatal variables; among neonatal variables there was a significant association with respiratory distress syndrome and neurological examination at discharge with an altered result.     

Hypocalcification and hypoplasia in primary teeth of pre-school children from different ethnic groups in South Africa

A study was completed in 1985/86 which examined the dental health of pre-school children from different ethnic groups and communities in South Africa: rural black, urban black, urban colored, urban Indian, and urban white. Enamel defects were recorded in primary teeth by use of the HHI, an index developed to measure hypocalcification and hypoplasia of enamel. The findings showed that colored children had the greatest number of enamel defects. The teeth most commonly affected were the maxillary anterior teeth and mandibular molar teeth. It is suggested that further epidemiological studies utilizing the HHI should be undertaken in pre-school children, especially from developing countries, to gain more information on the causes of enamel defects in the primary dentition and the possible use of such findings to predict nutritional health of individuals.     

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     

Association between developmental defects of enamel and dental caries in schoolchildren

Despite improvement, dental caries is still the main public oral health problem worldwide and the major cause of pain, tooth loss and chewing difficulties in children and adolescents; and it impacts negatively on oral health-related quality of life. A cross-sectional study of a multistage representative sample of 8–12-year-old Brazilian school children was carried out in order to investigate the association between enamel defects and dental caries. Children's mothers completed a questionnaire about socio-demographic and behavioural characteristics at home. Firth's bias reduced logistic regression models were undertaken to assess the association between the main exposure (enamel defects) and caries experience. The prevalence of any enamel defect was 64.0%; the prevalence of diffuse opacities, demarcated opacities and enamel hypoplasia was 35.0%, 29.5% and 3.7%, respectively. The prevalence of dental caries was 32.4%, with mean DMFT of 0.6 (SD, 1.2). Dental caries experience was more common among children who had enamel hypoplasia in their posterior teeth (OR = 2.79; 95% CI: 1.05, 6.51) than among those with none. In anterior teeth, there was no association. Enamel hypoplasia appears to be an important risk factor for dental caries.     

Presence of developmental defects of enamel in cystic fibrosis patients

PURPOSES: Cystic fibrosis (CF) is an autosomal recessive hereditary disease and is the frequently common lethal genetic pathology. The purposes of this study were to: (1) determine the presence of 3 different types of enamel defects: (a) demarcated opacities; (b) diffuse opacities; and (c) hypoplasia in the deciduous and permanent dentition of CF patients; and (2) compare with a control group. METHODS: The case group was defined as 13 patients who were diagnosed with CF and enrolled in a multiprofessional project of the Catholic University of Brasília (CUB), Brasilia, Brazil. All CF subjects were compared with control subjects selected from patients at the CUB. Each CF subject was individually paired with a control subject of similar sex and age. A full-mouth examination was carried out for the developmental defects of enamel (DDE) index. RESULTS: The most prevalent enamel defect in deciduous teeth was demarcated opacities present in 16% of the case group and in 7% of the control group. Although the defects were more prevalent in the case group, the difference was not statistically significant (P=0.57). The frequency of demarcated opacities was more prevalent in permanent teeth of the case group: 39% compared to 11% in the control group. For the control group, diffuse opacities were the more prevalent defects: 17% compared to 15% in the case group. The case group had more enamel defects in permanent teeth compared to the control (P=0.0003). CONCLUSIONS: In this study, enamel defects were frequently found in the permanent teeth of CF patients. Therefore, professionals who treat children should be alerted to promoting oral health among these patients.     

Prevalence and distribution by tooth type and surface of developmental defects of dental enamel in a group of 15- to 16-year-old children in South Wales

In 1984 the prevalence and distribution of developmental defects of dental enamel in 791 children aged 15-16 years was determined using the DDE index. The children were all residents of the county of South Glamorgan, Wales, which has a public water supply containing less than 0.1 mg fluoride/litre. The teeth were dried but not cleaned prior to examination and a dental operating light was used for illumination. Teeth with some type of defective enamel were seen in 50.1 per cent of children. White/single opacities were present in 28.3 per cent of children and white/diffuse, patchy opacities in 10.2 per cent of children. The enamel was abnormal in 5.71 per cent of all teeth with white/single opacities and white/diffuse, patchy opacities occurring in 1.81 per cent and 1.66 per cent of teeth respectively. There were no significant differences between boys and girls in terms of mouth or tooth prevalence of defects. Overall, 7.6 per cent of maxillary teeth were affected compared to 4.3 per cent of mandibular teeth. Most teeth were affected equally on right and left sides of the mouth except for maxillary lateral incisors and canines which had significantly more defects on the right (P less than 0.05 and P less than 0.005 respectively) and maxillary second molars, which had significantly more defects on the left (P less than 0.01). Maxillary central incisors (15.2 per cent) were affected by enamel defects most often followed by maxillary first molars (9.1 per cent) and maxillary lateral incisors and mandibular first molars (both 8.3 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of dental caries and enamel defects in Connecticut Head Start children

PURPOSE: The aim of this study was to determine the prevalence of dental caries and enamel defects in a sample of predominantly African American and Hispanic children from an inner city Head Start program located in Connecticut. METHODS: A total of 517 children were examined for dental caries and enamel defects. Children's caries experience was described using the dmfs/t indices, and dental defects were described using a modified developmental defects of enamel index. RESULTS: The mean dmfs was 3.0, and 38% of the children had caries. The prevalence of enamel defects was 49%. When analyzed by race/ethnicity no significant differences in dmfs scores or the prevalence of defects were observed. The majority of defects were located on anterior teeth, and the type of defect varied with the location. On the buccal surface of canines, hypoplasia accounted for 70% of the lesions. On maxillary anterior teeth, linear opacities accounted for 50% of the lesions. A positive association between enamel defects and caries was observed. CONCLUSIONS: The prevalence of caries and defects in these Head Start children was high, with most defects located on anterior teeth. Enamel defects were associated with an increased caries incidence.     

Risk factors in the occurrence of enamel defects of the first permanent molars among schoolchildren in Western Australia

Abstract – Background: The prevalence of enamel defects in the first permanent molars among children in Western Australia is higher than that reported for some European countries. The cause(s) of the defects, both white diffuse opacities and demarcated opacities, with or without hypoplasia, continue to be investigated. A recent review identified childhood illnesses and exposure to environmental toxins as putative causal factors for the occurrence of demarcated opacities (usually in association with hypoplasia). Diffuse opacities have been reported to be associated with exposure to the antibiotic amoxicillin, adjusted for otitis media and fluoride. The aim of this study was to examine the possible risk factors for enamel defects in the first permanent molars among children in Western Australia. Methods: Children attending pre‐primary schools (1999–2000 year of birth) in metropolitan Perth, Western Australia, were invited to participate in the study. In 2005, before the child’s first permanent molars had erupted, parents completed a questionnaire about the mother’s health during pregnancy, and their child’s health for the first 3 years. The first permanent molars were classified for type and extent of enamel defects using the modified Developmental Defects of Enamel (DDE) index. Caries experience and the presence of enamel defects on the deciduous molars and canines were also recorded using the WHO criteria. Bivariate, multinomial logistic and logistic regression analyses were used to test the factors for their influence on the occurrence of the enamel defects. Results: Five hundred and fifty children were examined for the occurrence of enamel defects on the first permanent molars. Multinomial logistic regression indicated that neonatal health conditions, prematurity (OR 2.75) and other health conditions (OR 2.40) were significant risk factors for the occurrence of diffuse enamel defects. Infection during the neonatal period was a strong risk factor for the occurrence of demarcated enamel defects (OR 6.88). Increased deciduous tooth caries experience increased the risk of demarcated enamel defects by 10% (OR 1.10) and living further from a heavy industrial area increased the risk of diffuse enamel defects nearly twofold (OR 1.93). Conclusions: Neonatal health factors were found to be important risk factors for the occurrence of enamel defects in first permanent molars. The effects of residential location and the association between deciduous tooth caries experience and enamel defects require further investigations.     

Prevalence of enamel hypoplasia and isolated opacities in the primary dentition

PURPOSE: Enamel hypoplasia is of interest to both the clinician and the basic scientist because it may indicate an increased risk for caries and can contribute to the understanding of enamel development. The purpose of this paper is to report the prevalence of enamel hypoplasia and isolated enamel opacities in a cohort of healthy, well-nourished children in Iowa. METHODS: The study sample consisted of 698 children examined at 4-5 years of age. Individual tooth surfaces were scored for the presence of enamel hypoplasia (EH) and isolated enamel opacities. Prevalence of EH and isolated opacities were determined by tooth type and by gender. RESULTS: Six percent of the children examined had at least one tooth with EH; 27% had at least one tooth with isolated enamel opacities. There was no difference in the prevalence of EH between boys and girls, but significantly more boys than girls had enamel opacities. CONCLUSIONS: The prevalence of enamel defects in this study group is comparable to that seen in other studies of normally developed children except that in this study, the primary tooth types most commonly affected with enamel hypoplasia or isolated opacities were mandibular second molars and maxillary second molars, respectively.     

Common dental conditions associated with dental erosion in schoolchildren in Australia

PURPOSE: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia. METHODS: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index. RESULTS: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002). CONCLUSIONS: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.     

Polychlorinated biphenyls cause developmental enamel defects in children

The aim of this study was to evaluate the effects of long-term exposure to polychlorinated biphenyls (PCBs) on developing dental enamel. 202 8- to 14-year-old children who were pre- and post-natally exposed to PCBs in the contaminated region of Bela Krajina, Slovenia, were studied. 202 controls from Brsljin were matched for age and sex. Risk assessment was based on the concentrations of toxic PCB congeners in the diet. Levels of PCBs in dentine were used to validate exposure. PCB levels were analysed by high-resolution gas chromatography. The prevalence of developmental defects of enamel was assessed using the FDI Index. Developmental defects of enamel in permanent teeth were found in 71.3% of exposed children, compared to 49.5% in the control group. The enamel was abnormal in 21.9% of the permanent index teeth of exposed children and in 12.7% of the control children. The difference was statistically significant (chi(2) = 84.18; p = 0.0019), mostly on account of demarcated opacities and hypoplasia. The extent of the defects was also greater in the exposed group (chi(2) = 61.3; p = 0.0001). No significant correlations were found between PCB exposure and developmental defects in deciduous teeth. In conclusion, our results showed that long-term exposure to PCBs may cause developmental defects of enamel.     

Distribution of developmental defects of tooth enamel by tooth-type in 11–12-year-old children in South Wales

The distribution of enamel developmental defects in 759 11-12-yr-old children from South Wales is described. Overall, 8% of maxillary teeth were affected compared to 3.6% of mandibular teeth. Most teeth were affected equally on right and left sides of the mouth except for maxillary lateral incisors, which had significantly more defects on the right (P less than 0.05) and maxillary first molars, which had significantly more defects on the left (P less than 0.025). Maxillary central incisors (18.7%) were affected by enamel defects most often followed by maxillary first molars (8.1%) and maxillary lateral incisors (7.2%). The ranking order of the teeth varied when the prevalence of the different types of defects was assessed. White demarcated opacities were seen most often in maxillary central incisors (10.8%), yellow demarcated opacities in maxillary first molars (1.8%), diffuse opacities in maxillary central incisors (6.6%) and hypoplasias in mandibular first premolars (1.5%). Defects of all types occurred most frequently on the buccal surfaces of the teeth. In premolar and molar teeth more defects occurred on the occlusal surface than on the lingual.     

Enamel defects and dental caries among Southland children

The aim of this study was to examine the prevalence, severity and associations of enamel defects and dental caries in a probability-based sample of 9- and 10-year-old children living in fluoridated Invercargill and the non-fluoridated towns of Gore, Winton and Queenstown, in Southland, New Zealand. DESIGN: The study was a cross-sectional survey of enamel defects and their associations in a random sample of 9- and 10-year-old children. METHOD: Parents of 600 children were sent a postal survey questionnaire which sought information on sociodemographic characteristics and fluoride exposure from different sources. Consent for dental examinations was also obtained and the children were examined in schools by the principal investigator (TDM). The Developmental Defects of Enamel (DDE) index was used to assess 10 index teeth, which were examined wet and uncleaned. An examination for caries was also carried out. Data were recorded electronically on a laptop computer, and images were taken of each child's anterior teeth using a digital camera. After univariate and bivariate analysis of the data, multivariate modelling was used to control for confounders and derive odds ratios for the prevalence of enamel defects. RESULTS: Four hundred and thirty-six children (mean age of 9.8 years) were examined, giving an effective participation rate of 74.5 percent. At the time of examination the majority of children had a mixed dentition with 77.1 percent of the children having experienced dental caries. Two-thirds of the sample had had deciduous caries experience, with a mean 4.4 surfaces affected. The prevalence of enamel defects of any type among these children was 51.6 percent, with that of demarcated opacities being 38.8 percent, and that of diffuse opacities being 24.1 percent; 5.5 percent had one or more hypoplastic defects. Diffuse opacities were more frequent among children who had lived all their lives in a fluoridated area (OR = 2.23; 95 percent CI 1.37, 3.63). Most of the diffuse opacities affected less than one-third of the labial surface of the index teeth, and the maxillary central incisors were the most commonly affected tooth. CONCLUSIONS: This study suggests that the prevalence of diffuse opacities among children who have lived their whole lives in a fluoridated area has not increased. The benefits of water fluoridation as a public health measure remain, with children continuously exposed to fluoridated water during their life having half the dental caries experience of those who have not. While this benefit also exacts a "biological price" in terms of a greater prevalence of diffuse opacities, the clinical, social and public health significanceof those opacities remains unclear.     

Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years

Abstract –  The aim of this study was to determine the prevalence of sequelae in the permanent anterior teeth following trauma in their predecessors, and also to verify the existence of association between the sequelae in the permanent teeth and the type of injury in their predecessors according to the age group at the time of injury. This study was performed based on data from the records of 169 boys and 138 girls who received assistance at the dental clinic of the State University of Rio de Janeiro from March 1996 to December 2004. The sample was collected from 753 traumatized deciduous teeth of children aged 0–10 years. The number of boys and girls with dental trauma corresponded to 55.0% and 45.0%, respectively. The more affected age period was between 1 and 4 years (75.3%). The most common type of traumatic injury was the intrusion (29.3%), followed by avulsion (14.1%). Concerning permanent dentition, the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors. It was not possible to find an association between the type of injury in primary teeth and sequelae in their successors in the studied age groups ( P  ≤ 1.00). The study concluded that discolorations of enamel and/or enamel hypoplasia (46.08%) were the most prevalent sequelae on the permanent dentition and that there was no significant statistical association between the occurrence of sequelae in the permanent teeth and the type of traumatic injury in their predecessors in the studied age groups.     

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.     

Developmental enamel defects in the primary dentition: aetiology and clinical management

Developmental enamel defects, presenting as enamel hypoplasia or opacities are caused by damage or disruption to the developing enamel organ as a result of inherited and acquired systemic conditions. The high prevalence of these defects in the primary dentition demonstrates the vulnerability of the teeth to changes in the pre‐ and postnatal environment. The presence of enamel hypoplasia increases the risk of primary teeth to early childhood caries and tooth wear as the defective enamel is thinner, more plaque retentive and less resistant to dissolution in acid compared to normal enamel. The purpose of this paper was to critically review the aetiology and clinical complications of developmental enamel defects in the primary dentition and propose recommendations for the clinical management of affected teeth.     

A cohort study on prevalence of dental caries concerning primary schoolchildren in one village of Niigata Prefecture

To review the previous preventive measures against the incidence of dental caries in children, we started to examine the state of dental health in children at the age of 18 months. The annual dental examination continued up to 12 years of age (sixgraders). Enrolled in this study were a total of 225 children living in a Town T and born between 1980 and 1982. Meanwhile, we made surveys in order to gauge the degree to which the subjects and their parents have concern for oral health. The findings and their relationships to the caries incidence were analyzed using an epidemiological technique. The annual dental examinations revealed that in primary dentition the incidence of caries tends to increase in 3-year-olds while in permanent dentition the carious process extends in 4–6 graders. By kind of teeth, primary molars accounted for 52% of the affected deciduous teeth. First molars made up 72% of all the decayed permanent teeth. Using the two caries cumulative indexes developed by our department for recording the prevalence and severity of tooth decay in the deciduous dentition and in the permanent dentition, respectively, we found that there is a correlation between the incidence of caries in the deciduous dentition and that in the permanent teeth. The two formulae are based on the cumulative number of decayed teeth that appeared in the deciduous dentition and permanent dentition for a given period of time. In order to find whether there is any correlation between caries attack and attention paid to the risk factors, we divided the subjects into two groups by the number of decayed teeth per person. In the group made up of those with many carious teeth, it was noted that between-meal snacks are most likely to produce caries in deciduous teeth, while lifestyle affects permanentteth.