An in vivo investigation of salivary properties,enamel hypomineralisation,and carious lesion severity in a group of Iraqi schoolchildren

International Journal of Paediatric Dentistry 2013; 23: 2–12 Background. Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post‐eruptively particularly in the presence of an unfavourable oral environment. Aims. To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect’s clinical presentation. Design. Recruitment consisted of 445 seven‐ to nine‐year‐old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub‐sample, equally divided as MH‐affected and non‐affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. Results. Molar hypomineralisation‐affected children have significantly higher mean caries scores compared to the non‐affected group. Dentinal carious lesions were ten times more frequent in teeth with post‐eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. Conclusion. Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.     

Risk factors in the occurrence of molar–incisor hypomineralization amongst a group of Iraqi children

International Journal of Paediatric Dentistry 2013; 23: 197–206 Background. Despite the worldwide increasing interest in the prevalence studies of molar–incisor hypomineralization (MIH), there is still insufficient evidence to verify the aetiological factors of this condition. Aims. To investigate risk factors involved in the development of MIH in a group of school‐aged Iraqi children. Design. Seven‐ to nine‐year‐old school children (823 of 1000 eligible, response rate of 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Mothers completed a medical history questionnaire‐based interview performed in the schools by a trained examiner. Results. For children with MIH, 6% reported no relevant medical history; the remaining 94% reported various medical conditions putatively associated with MIH compared with 70% for the non‐affected group. Post‐natal medical conditions (33.3%) were most frequently reported. When data were split into the possible risk effect groups, maternal psychological stress (OR, 3.24), frequent exposure to ultrasonic scans during the last gestational trimester (OR, 2.51) and birth order as a fourth sibling or later (OR, 3.17 and 5.73, respectively) were previously unreported significant risk factors and postulated as contributing to, or causing the defect. Conclusions. Children with MIH had experienced a greater number of medical conditions than their unaffected peers with no single health event identified as a risk factor.     

Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children

International Journal of Paediatric Dentistry 2013; 23: 48–55 Background. Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. Aim. To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. Design. A cluster sample of 809, 7‐ to 9‐year‐old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. Results. Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. Conclusions. The prevalence of HSPM was 6.6%. Over one‐third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.