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PubMed2005

The prevalence of Molar Incisor Hypomineralisation (MIH) in a group of Italian school children.

AIM: This epidemiological study in a group of Italian children was undertaken in order to increase our knowledge of the prevalence of Molar Incisor Hypomineralisation (MIH) in different European countries. METHOD: A population of school children aged 7.3 - 8.3 years, living in Lissone, Northern Italy, was examined for the presence and severity of MIH. RESULTS: Of a total of 227 children (113 females), 31 (13.7%) had MIH, the tooth prevalence in the permanent first molars being 5.8%. Fifteen children (6.6%) had demarcated opacities in the incisors with a tooth prevalence of 2.1%. The defects in the molars were mild with the exception of one child who had severe defects. CONCLUSION: MIH was quite common in this Italian town, and the prevalence figures were near those reported in Scandinavian countries but clearly higher than those from Dresden, Germany.

Child↗

PubMed2005

Asthma inhalers and subsurface enamel demineralisation: an in situ pilot study.

AIM: The purpose of this pilot study was to identify the subsurface enamel demineralising potential of two possible acidogenic lactose-based powders and their corresponding generic pump inhalers. METHODS: Ten healthy non-asthmatic adults participated in a 5- leg randomised crossover study including a 10% sucrose control. A twice-daily 400 microg dose of inhaler was applied in vitro to a demineralised enamel slab on the buccal flange of a mandibular removable appliance before in situ placement for 14 days each. Lesion parameters were determined using transverse microradiography and digitised image analysis. RESULTS: Minimal demineralisation occurred with sucrose, both pump and one powder inhaler. The remaining powder was associated with remineralisation (p = 0.29). Overall, mean lesion depth increased (p = 0.12). CONCLUSION: Asthma inhalers failed to demonstrate a significant acidogenic/cariogenic effect.

Administration, Inhalation↗

PubMed2005

Effect of regular fluoride gel application on incipient carious lesions.

OBJECTIVES: To evaluate the efficacy of weekly supervised tooth-brushing with a toothpaste and a 1.23% acidulated phosphate fluoride gel (APF) gel on white lesion reversal to treat incipient enamel lesions. DESIGN: A double-blind and randomized controlled trial. SAMPLE AND METHODS: Three-hundred seven to 12-year-old Brazilian schoolchildren who presented with white spots on the buccal surfaces of permanent upper incisors were randomly allocated to three groups. In group I, children underwent supervised tooth-brushing and APF gel (1.23%) for one minute once a week. In group II, children were subjected to a weekly supervised tooth-brushing and a topical application of placebo, whereas group III (control) received no intervention. An expert dental examiner performed all intra-oral examinations for dental caries (DMF-s and dmf-s) and oral hygiene (Visible Plaque Index, Gingival Blood Index). RESULTS: After three months, 258 children and 460 lesions were analyzed. The results of the clinical evaluation of arrested white spots did not differ significantly (p = 0.95) between the two experimental groups (57.9% in group I and 56.8% in group II) but differed significantly between them and the control group (p = 0.022). Logistic regression analysis identified gingival blood index (OR = 1.70, CI = 1.13 -2.55), DMF-s2 (OR = 1.61, CI = 1.07-2.43) and number of white spot lesions (OR = 1.76, CI = 1.04 to 2.98) as independent 'risk' factors for white spot lesion activities. On the other hand, supervised tooth-brushing with APF (OR = 0.55, CI = 0.34-0.91) or without APF (OR = 0.58, CI = 0.35-0.94) was a protective factor. CONCLUSIONS: These results suggest that the weekly supervised tooth-brushing was able to arrest enamel white spots and that poor oral hygiene increases the probability of keeping white spots active.

Acidulated Phosphate Fluoride↗

PubMed2005

Treatment management of first permanent molars in children with Molar-Incisor Hypomineralisation.

AIM: To study the treatment management of first permanent molars in children with Molar-Incisor Hypomineralisation (MIH). STUDY DESIGN: Retrospective analysis. METHODS: The records of the clientele of a private paediatric dental practice were scanned. Thirty-six cases of children fulfilling the diagnostic criteria of MIH were retrieved who had been followed for a mean period of 4.5 years, and 36 children of matching age and gender, and with similar follow-up period, were randomly selected from the same clientele to serve as controls. RESULTS: Children in the MIH group exhibited greater DMFS and smaller dmfs scores. The frequency of restorative intervention was greater in children of the MIH group (OREST=11.00, 95% C.I. 2.85-42.45). Stainless-steel crowns had been placed only on MIH group molars. The follow-up records revealed that only restorations in the MIH group needed retreatment. Fillings and sealants in the MIH group had a greater probability of needing retreatment than in the control group (OREST=3.10, 95% C.I. 1.60-6.01). CONCLUSIONS: Children affected by MIH may need to undergo a significant amount of restorative treatment at an early age. Moreover, fillings and sealants in MIH affected children have a greater probability of needing retreatment than in control group children.

Case-Control Studies↗

PubMed2005

Prevalence of enamel defects and MIH in non-fluoridated and fluoridated communities.

AIM: This was to study the prevalence of enamel defects and molar incisor hypomineralisation (MIH) in children attending Leeds Dental Institute (UK) and Westmead Dental Hospital, Sydney (Australia). METHODS: Prospective dental examinations were carried out on 25 children referred to two orthodontic departments. A questionnaire was completed to obtain background information and about previous fluoride (F) exposure followed by an oral examination. First permanent molars and permanent incisors were examined for presence, type and severity of enamel defects using the modified DDE screening index. Chi square tests were used to compare results. RESULTS: Data for 24 children in Sydney and 20 in Leeds presented with at least one enamel defect. Of 300 teeth examined, 155 in Sydney and 82 in Leeds had a defect (p < 0.005). Severity of enamel defects was higher in Sydney. The children presenting with any type of enamel defect in at least one incisor or molar were 21 in Sydney and 10 in Leeds. However, if only demarcated defects were considered, the number in Sydney dropped to 11 and in Leeds remained at 10. CONCLUSIONS: There was a higher prevalence of enamel defects in those children living in F Sydney than in non-F Leeds, but the prevalence of MIH was the same supporting the view that F is not associated with the aetiology of MIH.

Adolescent↗

PubMed2006

[The preventive effectiveness in reducing tooth decay and decalcification of different concentration of fluoride toothpaste for orthodontic patients].

OBJECTIVE: To investigate the preventive effectiveness in reducing tooth decay and decalcification of different concentration of fluoride toothpaste for orthodontic patients. METHODS: 86 patients were divided into the first test group and the second test group. The patients of the first test group brushed tooth with 1.1% sodium fluoride and acidulated phosphate gel. The patients of the second test group brushed tooth with 0.243% sodium fluoride in a silica base. The extent of facial tooth decay and decalcification of the twelve upper and lower teeth from right cuspid to left cuspid was scored blindly and independently by four observers after 12 months of product use. The scores were rated either one (having tooth cavity/decalcification) or zero (no tooth cavity/decalcification). Four observer's readings were averaged per tooth, and then per patient for the two treatment groups. RESULTS: After 12 months of product use, the mean caries score of the first test group was 0.326, and the mean caries score of the second test group was 0.490. There was significant difference between them. CONCLUSION: A gel system containing 1.1% sodium fluoride and acidulated phosphate provides a clinically better efficacy in reducing tooth decay and decalcification than does a toothpaste containing 0.243% sodium fluoride in a silica base under and adjacent to orthodontic brackets used in orthodontic therapy.

Dental Caries↗

PubMedDate not supplied

Medical approach to dental caries: fight the disease, not the lesion.

Dental caries is one of the most prevalent and costly diseases in the United States and throughout the world. Although the manifestation of the disease is the dissolution of tooth structure, the biological nature of the disease is a microbial infection. Traditional dentistry has been heavily focused on repairing damaged tooth structure via surgical approaches. The advancement of microbiology and engineering is bringing a medical revolution to dentistry. The on-going exciting progress in caries research has offered us great opportunities to better understand, detect, and monitor the disease. Most importantly, these new biological discoveries and technological developments allow us to address the etiological cause of the disease (microbial infection), which can lead to more effective treatments and prevention of dental caries.

Bacteriological Techniques↗

PubMedDate not supplied

Molar incisor hypomineralization: review and recommendations for clinical management.

Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molars (FPMs) that are associated frequently with affected incisors. Etiological associations with systemic conditions or environmental insults during the child's first 3 years have been implicated. The complex care involved in treating affected children must address their behavior and anxiety, aiming to provide a durable restoration under pain-free conditions. The challenges include adequate anaesthesia, suitable cavity design, and choice of restorative materials. Restorations in hypomineralized molars appear to fail frequently; there is little evidence-based literature to facilitate clinical decisions on cavity design and material choice. A 6-step approach to management is described: (1) risk identification; (2) early diagnosis; (3) remineralization and desensitization; (4) prevention of caries and posteruption breakdown; (5) restorations and extractions; and (6) maintenance. The high prevalence of MIH indicates the need for research to clarify etiological factors and improve the durability of restorations in affected teeth. The purpose of this paper was to describe the diagnosis, prevalence, putative etiological factors, and features of hypomineralized enamel in molar incisor hypomineralization and to present a sequential approach to management.

Child, Preschool↗

PubMedDate not supplied

Microshear bond strength of resin composite to teeth affected by molar hypomineralization using 2 adhesive systems.

PURPOSE: When restoring hypomineralized first permanent molars, placement of cavo-surface margins can be difficult to ascertain due to uncertainty of the bonding capability of the tooth surface. The purpose of this study was to investigate the adhesion of resin composite bonded to control and hypomineralized enamel with an all-etch single-bottle adhesive or self-etching primer adhesive. METHODS: Specimens of control enamel (N=44) and hypomineralized enamel (N=45) had a 0.975-mm diameter composite rod (Filtek Supreme Universal Restorative) bonded with either 3M ESPE Single Bond or Clearfil SE Bond following manufacturers' instructions. Specimens were stressed in shear at 1 mm/min to failure (microshear bond strength). Etched enamel surfaces and enamel-adhesive interfaces were examined under scanning electron microscopy. RESULTS: The microshear bond strength (MPa) of resin composite bonded to hypomineralized enamel was significantly lower than for control enamel (3M ESPE Single Bond=7.08 +/- 4.90 vs 16.27 +/- 10.04; Clearfil SE Bond=10.39 +/- 7.56 vs 19.63 +/- 7.42; P=.001). Fractures were predominantly adhesive in control enamel and cohesive in hypomineralized enamel. Scotchbond etchant produced deep interprismatic and intercrystal porosity in control enamel and shallow etch patterns with minimal intercrystal porosity in hypomineralized enamel. Control enamel appeared almost unaffected by SE Primer; hypomineralized enamel showed shallow etching. The hypomineralized enamel-adhesive interface was porous with cracks in the enamel. The control enamel-adhesive interface displayed a hybrid layer of even thickness. CONCLUSIONS: The microshear bond strength of resin composite bonded to hypomineralized enamel was significantly lower than for control enamel. This was supported by differences seen in etch patterns and at the enamel-adhesive interface.

Acid Etching, Dental↗

PubMed2006

[Microtensile bond strength and morphological evaluations of total-etch and self-etch adhesives to caries-affected dentin].

OBJECTIVE: To evaluate the microtensile bond strength and bond interface of total-etch or self-etch adhesives to normal dentin and caries-affected dentin. METHODS: A total of 20 molars with occlusal caries lesion were used. The caries-affected dentin was obtained by removing the caries-infected dentin under the guidance of the caries detector. Beyond the level of caries-affected dentin all the enamel and partial dentin were removed. The adhesive systems, two total-etch adhesives (All-Bond 2, Prime&Bond NT) and two self-etch adhesives (Clearfil SE Bond, Xeno III) were applied respectively under the instructions of manufacturers. A block of composite resin was build up superficially. All the teeth were sectioned to obtain bar-shaped specimens with bonded surface area about 0.9 mm x 0.9 mm. The specimens were divided into normal dentin group and caries-affected dentin group via stereomicroscope. The bond strength was tested in a microtensile tester with a crosshead speed of 1 mm/min. The mean values of bond strength were compared using two-way ANOVA. The bonding interface between the dentin and adhesives was qualitatively evaluated under the observation of scanning electron microscope (SEM). RESULTS: Two-way ANOVA revealed a significant influence of both the type of dentin and the adhesive systems tested on microtensile bond strength values. All the adhesives attained higher strength in normal dentin. In normal dentin, there was no significant difference between total-etch and self-etch adhesives. In caries-affected dentin, bond strength of Xeno III was significantly lower than the others. For SEM, the hybrid layer in caries-affected dentin was thicker but more porous than that in normal dentin. Compared with normal dentin, there was fewer resin tag exhibited in caries-affected dentin and no lateral branches were observed. CONCLUSIONS: The total-etch adhesive had higher bond strength than self-etch adhesive systems in caries-affected dentin.

Acid Etching, Dental↗

PubMed2006

Diagnosis and treatment of molar incisor hypomineralization.

Molar incisor hypomineralization (MIH) is a relatively common condition that varies in clinical severity and can result in early loss of the permanent 6-year molars. The etiology of MIH remains unclear, and the diagnosis can be confused with more generalized enamel defects such as those that occur in amelogenesis imperfecta. The management of MIH depends largely on the severity of the enamel defect. Degrees of hypomineralization can range from mild enamel opacities to enamel that readily abrades from the tooth as it emerges into the oral cavity. Usually, severely affected molars are extremely hypersensitive, prone to rapid caries development, and can be difficult to manage in young patients. The purpose of this article is to review approaches to diagnosing and treating MIH.

Dental Enamel↗

PubMed1991

Fluoride-releasing core build-up materials and artificial caries.

UNLABELLED: This study examined the effect of fluoride-releasing core build-up materials upon both enamel and root demineralization in an artificial caries system. Thirty extracted human molars were randomly assigned to three treatment groups consisting of (1) conventional composite core build-up paste, (2) fluoridated core build-up paste and (3) glass cermet. Teeth were thermocycled 350 times between 5 degrees C and 55 degrees C using 30-second dwell times. Acid-resistant varnish was placed on the specimens to within 1 mm of the restoration and the teeth were subjected to an artificial-caries challenge at pH 4.2 for 72 hours. Teeth were then sectioned and the thin sections photographed using a polarized light microscope. Areas of the artificial-caries lesions were measured using a sonic digitizing pad. Mean lesion area (in arbitrary units from the digitizing pad) on enamel for Group 1 was 3.76 +/- 0.54; Group 2 was 2.53 +/- 1.17 and Group 3 was 2.32 +/- 0.68. Mean lesion area on root for Group 1 was 3.04 +/- 0.54; Group 2 was 2.34 +/- 0.58 and Group 3 was 2.51 +/- 0.53. ANOVA with Duncan's multiple range test of contrast indicates a significant difference (P less than 0.001) on both enamel (35 +/- 3%) and root (20 +/- 3%) between the non-fluoridated product and the two fluoridated products. There were no significant differences between Group 2 and 3. CLINICAL SIGNIFICANCE: This artificial caries study indicates that a fluoride-releasing core material may be of value in preventing demineralization of tooth structure adjacent to the restorative core material.

Analysis of Variance↗

PubMed1990

[The crystallinity of hypomineralized rat enamel caused by fluoride administration].

It has been well known that there are extreme amounts of inter-crystalline spaces and large amounts of enamel matrix in fluorosed human enamel. Our previous study discussed the fact that amelogenins in developing fetal enamel matrix protein may have a role in regulating or controlling enamel crystal growth. These results positively suggest that amelogenins degradation may be associated with the etiology of fluorosed enamel. The purpose of this study was to examine the relationship of the crystallinity of fluorosed enamel of rats and the molecular weight of enamel matrix protein. The crystallinity of fluorosed enamel of rats, caused by the ingestion of fluoride containing water was evaluated with the microbeam x-ray diffraction analysis and the molecular weight of enamel matrix protein was examined by SDS-polyacrylamide-gel electrophoresis. The results obtained in the study are summarized as follows. 1) The plasma fluoride level of rats increased linearly with the fluoride concentration in the drinking water. 2) The microradiographs of maturing incisor enamel of the group with 100 ppmF- and 200 ppmF- injected showed diffused radiolucent zone from the subsurface toward the dento-enamel junction. The disturbances in enamel mineralization were most apparent in the 200 ppmF- group. 3) The crystallinity of the radiolucent zone of the fluorosed enamel decreased in both the a and c-axis directions, and particularly decreased more in the a-axis compared with the control. 4) The pattern of the SDS-polyacrylamide gel electrophoresis of the enamel protein in the mature stage showed higher remaining molecular weight of amelogenins in rats in the 100 ppmF- and 200 ppmF- group. These results suggest that in hypomineralized enamel caused by long-term administration of fluoride containing water, the degradation of amelogenin protein was disturbed, and consequently the crystallinity of enamel apatite decreased.

Amelogenin↗

PubMed1990

[Study on adhesion mechanism of MMA-TBBO resin to dentin. A model experiment using decalcified dentin].

As a model experiment to understand the mechanism of adhesion of the MMA-TBBO resin to dentin, MMA-TBBO was polymerized using a decalcified dentin sheet treated with aqueous citric acid (CA) solutions of copper fluoride (CF), ferric fluoride (FF), or ferric chloride (FC), which are usually used as treating agents in the bonding of the resin to dentin. The curing time for MMA-TBBO resin was considerably reduced on the decalcified dentin sheet treated with FC-CA, CF-CA or FF-CA at an appropriate concentration. Polymerization of MMA-TBBO resin was accelerated in the presence of a fluoride ion. Molecular weight of PMMA depended on the site of polymerization; PMMA polymerization inside the decalcified dentin sheet gave the highest and that outside gave the lowest molecular weight in the presence of an appropriate amount of ferric or cupric ion. These results suggested that ferric compounds adsorbed to decalcified dentin are involved in the polymerization of MMA and thus will influence the bond strength of the MMA-TBBO resin to dentin.

Acrylic Resins↗

PubMedDate not supplied

[Antimicrobial activity of orthodontic band cements].

The prevalence of enamel decalcification and caries beneath orthodontic bands, has indicated the need for a new enamel binding adhesive orthodontic cement. The purpose of this study was to evaluate the antimicrobial activity, in vitro, on Streptococcus mutans and Lactobacillus, acidophillus, of three materials used to cements the orthodontic bands. The cements studied were: Zinc phosphate cement, Glass-ionomer cement, and Policarboxylate cement. Thirty petri plates were seeded with S. mutans, and thirty with L. acidophillus; on each plate three pellet were placed, one of each cement studied. Petri plates were incubated under microaerophilic conditions at 37 C, and checked at 72 hrs. for Streptococcus, mutans, and four days for Lactobacillus acidophillus to evaluate the inhibition zone. The results were tabulated for each material. It was demonstrated that exists important variations in the antimicrobial properties of the materials studied, as in the microbial sensitivity to these cements.

Dental Cements↗

PubMed1990

[Relationship between length of resin tag and bond strength of bonding adhesive].

It is well known that the bond strength of direct bonding adhesive to etched enamel is dependent upon the formation of resin tags. So it is considered that there is a significant correlation between the bond strength and the length and shape of resin tags. However, there are very few reports on this correlation. In this study, a method of combining halogenated methacrylate and electron-probe microanalyzer (EPMA) was applied for measurement of resin tag length in order to investigate the correlation between the bond strength and resin tag length. Two experimental light cured adhesives were prepared for this study. One (CI-U) was prepared by blending microfiller (30 wt%) to the mixture of di (1-methacryloyl-oxyethyl-2-chloromethyl)-2,2,4-trimethylhexamethylene dicarbamate (50 wt%) and triethylene glycol dimethacrylate (TEGDMA: 59 wt%) and the other (Br-B) was prepared by blending microfiller (30 wt%) to the mixture of Bis-GMA (22.2 wt%), TEGDMA (65.9 wt%) and tetrabromobisphenol-A-glycidyl methacrylate (4Br-Bis GMA: 11.9 wt%). Preparation of 2%, 10%, 37%, and 60% phosphoric acid solutions, 2%, 5%, 10%, and 30% maleic acid solutions and 2%, 5%, 10%, and 30% citric acid solutions was carried out for use as etchants. The consistency and the bond strength to etched enamel for the adhesives and the amount of decalcification for the etchants were measured. The etched enamel surfaces, the resin tags on resin surfaces and the interfaces between the resin and enamel were observed with a SEM. The results were as follows: 1) The consistency of Cl-U was higher than that of Br-B. 2) The amount of decalcification was proportional to acid concentration, except for phosphoric acid solution. The amount of decalcification decreased in the order of citric acid solution, maleic acid solution and phosphoric acid solution when the concentration was 2% and 10%. 3) The SEM micrographs revealed that the enamel surface treated with the etchants containing a high concentration of acid was rougher. 4) The bond strength increased with increasing the concentration of the etchants except for the bond strength of Cl-U after being immersed in 37 degrees C water for 30 days and being thermal cycled. The bond strength for Cl-U was reduced greater than that of Br-B by long-term water immersion and thermal cycling.(ABSTRACT TRUNCATED AT 400 WORDS)

Acid Etching, Dental↗

PubMed1989

Microleakage channels: scanning electron microscopic observation.

Resin casts were made of microleakage channels surrounding amalgam restorations in vitro. After demineralizing the tooth and digesting the remaining organic matrix, the amalgam restorations covered with the resin casts were examined using a scanning electron microscope. An extensive reticular network of channels was observed on restorations which were placed in cavities lined by smear layers. Amalgam restorations placed in cavities devoid of smear layers exhibited fewer microleakage channels.

Dental Amalgam↗

PubMed1995

Microscopic appearance of enamel white-spot lesions after acid etching.

Ultrastructural changes in surface characteristics of enamel white-spot lesions were compared with changes in the adjacent clinically sound enamel after they were etched with 30% phosphoric acid. Ten human permanent first molars exhibiting natural white-spot lesions were used as study specimens. The lesion surfaces and their adjacent sound enamel were etched with 30% phosphoric acid for 60 seconds. Specimens were then evaluated by polarized light microscopy, scanning electron microscopy, and energy-dispersive spectroscopy. The acid etching produced a porous surface on both the white-spot lesion and the surrounding sound enamel. However, the lesion surface appeared to be more resistant to acid and dissolved less than adjacent enamel. This difference in acid solubility produced a steplike appearance between a white-spot lesion and its adjacent enamel surface. Energy-dispersive spectroscopy demonstrated no difference in relative calcium-phosphorus ratios among the acid-etched white-spot lesion, acid-etched sound enamel, and unetched sound enamel.

Acid Etching, Dental↗