Aluhê Lopes Fatturi

Background Certain genes present variants associated with molar-incisor hypomineralization (MIH) pathogenesis, especially genes encoding enamel development proteins related to morphogenesis, immune response, and hormone transcription and reception, demonstrating that MIH is likely a gene-environment issue with multiple genes having small individual effects.

Background: Polymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE).Aim: To evaluate the existing literature on genetic polymorphisms associated with DDE.Design: This systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle–Ottawa Scale was used to assess the risk of bias.Results: One thousand one hundred and forty‐six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety‐two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar–incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions.Conclusion: MIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.

Polymorphisms in the COMT gene can alter enzymatic functions, raising levels of endogenous catecholamines, which stimulates beta-adrenergic receptors related to pain. This study aimed to evaluate whether a polymorphism in the COMT gene (rs4818) is associated with dental pain in children.

Introdução: A hipomineralização molar incisivo (HMI) é uma alteração disfuncional na qualidade da estrutura do esmalte, afetando molares e incisivos permanentes. Essa disfunção pode ser classificada em diferentes severidades, sendo elas; leve, moderada e severa, tendo diferentes formas de tratamento, como, verniz fluoretado, cimento de ionômero de vidro e resina composta. Objetivo: Objetivo desse trabalho é relatar um caso clínico com abordagens terapêuticas, utilizando CIV quimicamente e fotoativado e verniz fluoretado fotoativado para intervenção da HMI. Relato do caso: O paciente procurou atendimento com queixa de sensibilidade dentária, para obter diagnóstico da causa da sensibilidade foi realizado anamnese complementada pelo exame clínico e radiográfico, nos quais se observaram HMI leve (somente opacidade) nos incisivos centrais inferiores e primeiros molares permanentes superiores e HMI severa (com perda de estrutura) nos primeiros molares permanentes inferiores. Os dentes acometidos por HMI severa foram restaurados com cimento ionômero de vidro através da técnica de restauração atraumática, e os dentes acometido por HMI leve foram remineralizados através de aplicação de verniz de flúor fotopolimerizavel. Considerações finais: Foi possível observar que a abordagem terapêutica foi eficiente na diminuição sensibilidade dentária relatada pelo paciente.

Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.

Objective: To evaluate systemic exposures associated with molar incisor hypomineralization (MIH).Methods: This systematic review was performed using published observational studies that evaluated the systemic exposures associated with MIH. The sources of articles searched were PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and Grey literature. The risk of bias was analysed according to the Newcastle‐Ottawa Scale for quality assessment. The meta‐analysis was performed considering the exposures during the prenatal, perinatal and postnatal periods using the CMA software.Results: A total of 4207 articles were identified. Twenty‐nine studies were eligible for inclusion and 27 were included in the meta‐analysis. The studies presented low and moderate risks of bias, except for one that was classified as having a high risk of bias. Maternal illness during pregnancy (OR 1.40; 95% CI 1.18‐1.65, P < 0.0001) and psychological stress (OR = 2.65; 95% CI 1.52‐4.63; P = 0.001) was observed to be significantly associated with higher odds of MIH. During the perinatal period, caesarean delivery (OR = 1.32, 95% CI 1.11‐1.57, P = 0.001) and delivery complications (OR = 2.06; 95% CI 1.47‐2.88, P < 0.0001) were also associated with MIH. In the postnatal period, only respiratory diseases (OR = 1.98; 95% CI 1.45‐2.70, P < 0.0001) and fever (OR = 1.50; 95% CI 1.22‐1.84; P < 0.0001) were associated with higher prevalence of MIH. The evidence was graded as very low quality.Conclusions: Maternal illness, psychological stress, caesarean delivery, delivery complications, respiratory diseases and fever during the first years of a child's life were significantly associated with a higher odds of MIH. However, this should be interpreted with caution, once the primary studies were observational, with serious limitations according to the risk of bias, imprecision, and inconsistency. Further, well‐designed cohort studies are still required.

This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.