Prevalence, Clinical Presentation, and Associated Sociodemographic Characteristics of Molar Hypomineralization in Indiana, USA

Indiana University-Purdue University Indianapolis (IUPUI)Molar Hypomineralization (MH) of the first permanent molars (FPMs) and the second primary molars (SPMs) is a common developmental defect of enamel, with global prevalence of 14% and 5% respectively. Children with MH represent a special pediatric population because their affected molars have extreme susceptibility to enamel breakdown, decay and tooth sensitivity. Although the problem of MH has been described almost twenty years ago mainly through reports from Europe, there is very little information about the problem from the USA. In this dissertation, MH was explored both from the perspectives of pediatric dentists’ (PDs) and at population level. The majority of the survey respondents perceived MH prevalence to be <10% in their clinical practice (62%). The most cited clinical challenge in managing MH teeth was “long-term success of restorations” (79%). When analyzed individually, responses differed significantly for different demographics and educational characteristics of the respondents (p<0.05). At population level, MH of the FPMs (Molar Incisor Hypomineralization (MIH) cohort: 337 schoolchildren, average age 9 years) and of the SPMs (Hypomineralized Second Primary Molar (HSPM) cohort: 423 schoolchildren, average age 7 years) had prevalence estimates of 13% and 6% respectively. In the MIH cohort, water fluoridation or non-Hispanic Black race/ethnicity was significantly associated with higher collective prevalence of enamel defect (EDs) (P<0.05), but not with the prevalence of MH of the FPMs. In the HSPM cohort, race/ethnicity was significantly associated with higher overall prevalence of EDs of SPMs, but not with the HSPM prevalence. Older age group (>10 years), living in central Indiana, and water fluoridation were significantly associated with higher overall prevalence of EDs (P<0.01), but not with the HSPM prevalence. Caries experience was significantly higher in children with MH of FPMs and/or SPMs than in the group without MH. We concluded that USA pediatric dentists’ respondents were well aware of the MH problem, but demonstrated discrepancies in different aspects of the MH problem. At population level, MIH and HSPM were common presentation with prevalence estimates similar to the global figures. Certain demographic characteristics were significantly associated with the overall prevalence of the enamel defects of the examined teeth

Oral health of visually impaired schoolchildren in Khartoum State, Sudan

BACKGROUND: Although oral health care is a vital component of overall health, it remains one of the greatest unattended needs among the disabled. The aim of this study was to assess the oral health status and oral health-related quality of life (Child-OIDP in 11-13-year-old) of the visually challenged school attendants in Khartoum State, the Sudan. METHODS: A school-based survey was conducted in Al-Nour institute [boys (66.3%), boarders (35.9%), and children with partial visual impairment (PVI) (44.6%)]. Two calibrated dentists examined the participants (n=79) using DMFT/dmft, Simplified Oral Hygiene Index (OHI-S), dental care index, and traumatic dental injuries (TDI) index. Oral health related quality of life (C-OIDP) was administered to 82 schoolchildren. RESULTS: Caries experience was 46.8%. Mean DMFT (age≥12, n=33) was 0.4 ± 0.7 (SiC 1.6), mean dmft (age<12, n=46) was 1.9 ±2.8 (SiC 3.4), mean OHIS 1.3 ± 0.9. Care Index was zero. One fifth of the children suffered TDI (19%). Almost one third (29%) of the 11–13 year old children reported an oral impact on their daily performances. A quarter of the schoolchildren (25.3%) required an urgent treatment need. Analysis showed that children with partial visual impairment (PVI) were 6.3 times (adjusted) more likely to be diagnosed with caries compared to children with complete visual impairment (CVI), and children with caries experience were 1.3 times (unadjusted) more likely to report an oral health related impact on quality of life. CONCLUSIONS: Visually impaired schoolchildren are burdened with oral health problems, especially caries. Furthermore, the 11-13 year olds' burden with caries showed a significant impact on their quality of life

Infant oral mutilation (IOM) related to traditional practices among inner city pre-school children in Sudan

Background: The term Infant Oral Mutilation (IOM) refers to the aggressive cultural rituals where primary canine tooth germs of infants are enucleated for therapeutic reasons.Objectives: To determine the prevalence and risk factors for IOM among inner city pre-school children in Khartoum.Methods: In this cross-sectional study, 212 randomly selected children from twelve government pre-schools in Khartoum were examined for the presence of IOM. Socio-demographic, feeding and teething-related data were collected by self-administered questionnaires.Results: The mean age of the sample was 4.7 years. The prevalence of clinical IOM was 10.8%. Multivariable regression analysis revealed that children who suffered from diarrhea during teething were 7.15 times more likely to have clinical IOM over their counterparts (p&lt;0.0001). Mothers who were educated below elementary school level were 2.69 times more likely to have children showing clinical IOM (p= 0.0369).Conclusion: The present study showed that the practice of IOM is common among inner city children. Certain teething-related symptoms especially diarrhea and maternal education could be strong determinants of the malpractice of IOM.Keywords: Infant oral mutilation (IOM), traditional practices, pre-school children, Sudan

Enhancing predicted fluoride varnish efficacy and post-treatment compliance by means of calcium-containing gummy bears

Objectives This study determined whether consumption of calcium-containing gummies prior to fluoride varnish application enhances plaque fluoride retention and compliance with post-varnish application instructions. Methods The present study followed a multi-center, parallel, randomized, and laboratory analyst-blind design. Following IRB approval, parent consent and child assent, 44 subjects (7–12 years), were randomized to either gummy or no-gummy study groups. A baseline plaque sample was obtained after a wash-out period. Fluoride varnish (5% NaF) was applied; subjects in the gummy group received two calcium-containing gummies prior to varnish application. Subjects were given two questionnaires to complete (subject and parent) to investigate adherence to post-treatment instructions. Three days later, a second plaque sample was obtained. Plaque was analyzed for plaque fluid and solid fluoride concentrations. Fluoride data were analyzed using Wilcoxon Rank Sum tests, questionnaire data using Pearson chi-square tests. Results Plaque fluid fluoride did not change pre- to post-treatment in the gummy group (mean ± sd: 8.8 ± 5.7 μmol/l vs. 10.0 ± 6.3 μmol/l; p = 0.265) or in the no-gummy group (8.1 ± 4.4 μmol/l vs. 16.1 ± 20.0 μmol/l; p = 0.058). Groups were not different for plaque fluid fluoride pre-treatment (p = 1.000), post-treatment (p = 0.904), or change (p = 0.904). Plaque solid fluoride did not change pre- to post-treatment in the gummy group (0.89 ± 1.10 μmol/g vs. 1.37 ± 1.77 μmol/g; p = 0.073) or in the no-gummy group (0.68 ± 0.77 μmol/g vs. 2.01 ± 5.00 μmol/g; p = 0.190). Groups were not different for plaque solid fluoride pre-treatment (p = 1.000), post-treatment (p = 0.466), or change (p = 0.874). No significant differences were found between groups for questionnaire responses. Conclusion This study failed to demonstrate an effect of calcium-containing gummies in enhancing plaque fluoride retention

Infant oral mutilation (IOM) related to traditional practices among inner city pre-school children in Sudan

Background: The term Infant Oral Mutilation (IOM) refers to the aggressive cultural rituals where primary canine tooth germs of infants are enucleated for therapeutic reasons. Objectives: To determine the prevalence and risk factors for IOM among inner city pre-school children in Khartoum. Methods: In this cross-sectional study, 212 randomly selected children from twelve government pre-schools in Khartoum were examined for the presence of IOM. Socio-demographic, feeding and teething-related data were collected by self-administered questionnaires. Results: The mean age of the sample was 4.7 years. The prevalence of clinical IOM was 10.8%. Multivariable regression analysis revealed that children who suffered from diarrhea during teething were 7.15 times more likely to have clinical IOM over their counterparts (p&lt;0.0001). Mothers who were educated below elementary school level were 2.69 times more likely to have children showing clinical IOM (p= 0.0369). Conclusion: The present study showed that the practice of IOM is common among inner city children. Certain teething-related symptoms especially diarrhea and maternal education could be strong determinants of the malpractice of IOM

Molar-Incisor Hypomineralization Studies

The problem of demarcated hypomineralization defects of the permanent first molars (molar-incisor hypomineralization [MIH]) has been an emerging issue for oral health professionals around the globe. Yet, the first set of US-based epidemiologic data on MIH took as long as 2 decades from the time when MIH was first described by Weerheijm and colleagues.1 In response to the June JADA article titled “Prevalence of Molar-Incisor Hypomineralization and Other Enamel Defects and Associated Sociodemographic Determinants in Indiana,” (Tagelsir Ahmed A, Soto-Rojas AE, Dean JA, Eckert GJ, Martinez-Mier EA, JADA. 2020;151[7]: 491-501), we attempt to highlight some of the challenges encountered during the course of an MIH epidemiologic school-based data collection effort. The routes and challenges we describe below are contemplations based on 2 US MIH school studies from Wisconsin and Indiana.2,

Dental caries and dental care level (restorative index) in children with diabeltres mellitus type 1

Introduction.  The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes. Materials and methods.  The study group consisted of 52 children and adolescents, 3–16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF-index both at cavity and non-cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes-related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc. Conclusion.  It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes-associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance

U.S. Pediatric Dentists’ Perception of Molar Incisor Hypomineralization

Purpose: The purpose of this survey-based study was to target U.S. pediatric dentists in the Midwest region to determine their knowledge, perceptions, and clinical management strategies of molar incisor hypomineralization (MIH). Methods: After obtaining appropriate authorizations, all pediatric dentists identified by the American Academy of Pediatric Dentistry's 2016 to 2017 membership directory in the 12 Midwest states were invited to take part in the study. The questionnaire, adopted from previous studies, incorporated information of the participants' demographics and educational/clinical backgrounds and MIH-focused questions. Descriptive statistics and chi-square tests were used for analysis. An alpha level less than 0.05 was considered statistically significant. Results: A total of 251 out of 975 surveys were completed (26 percent). Nearly all participants were familiar with MIH. The majority reported the MIH prevalence to be less than 10 percent in their clinical practice (62 percent). Most respondents were either very confident (65 percent) or confident (34 percent) when diagnosing teeth with MIH. The most cited clinical challenge in managing MIH teeth was "long-term success of restorations" (79 percent). When analyzed individually, responses differed significantly for different demographics and educational characteristics of the respondents (P<0.05). Conclusion: MIH is generally well acknowledged by U.S. Midwest pediatric dentists, with differences related to their perceptions of the condition's prevalence as well as clinical and restorative management challenges

Prevalence of molar-incisor hypomineralization and other enamel defects and associated sociodemographic determinants in Indiana

Background The aim of this study was to determine the prevalence and severity of molar-incisor hypomineralization (MIH) in a cohort of school-aged children in Indiana. Methods A calibrated examiner screened eligible school-aged children for MIH and other enamel defects. The authors used the integrated Modified Developmental Defects of Enamel Index and the European Academy of Pediatric Dentistry criteria to examine the permanent first molars, permanent incisors, and primary second molars. The authors used descriptive statistics, exact 95% confidence intervals, and χ2 tests for analysis (α = 5%). Results A total of 337 participants (mean [standard deviation] age, 9.1 (1.7) years; 52% 6 through 8 years; 66% non-Hispanic white) were examined. The prevalence estimate for MIH was 13% as opposed to a 52% prevalence estimate for any enamel defect (AED) of any of the index teeth. Living in an area with water fluoridation levels greater than 0.7 parts per million or being non-Hispanic black was significantly associated with higher prevalence of AED (P < .05) but not with the prevalence of MIH. Demarcated opacities were the most prevalent defects (43%), followed by atypical restorations (32%). Higher age and higher number of MIH-affected surfaces were associated with larger MIH defect extension (P < .05). Conclusions Nearly 1 in 6 children in Indiana had at least 1 permanent first molar with MIH. Water fluoridation levels and race or ethnicity were associated with the prevalence of AED but not with MIH prevalence