Ana Maria Barros Chaves

The Influence of Enamel Defects on the Development of Early Childhood Caries in a Population with Low Socioeconomic Status: A Longitudinal Study

The purpose of this study was to evaluate the influence of enamel defects in the development of dental caries and their association with feeding practices and oral health behaviors in a cohort study of low-socioeconomic children from birth to 36 months of age in northeastern Brazil. Subjects were registered at birth and examined from 12 to 36 months of age. At baseline, 246 children were examined and at follow-up 228. The teeth were clinically examined and dried with gauze under natural light. Enamel defects were determined using the Developmental Defects of Enamel (DDE) index. Dental caries was determined using WHO criteria. Data were analyzed using descriptive and analytical techniques. At 36 months 78.9% infants presented at least one tooth with enamel defects and 25% of the children had at least one decayed tooth. A total of 16.9% teeth with enamel defects had become decayed (p = 0.0001). Opacity with enamel hypoplasia was the defect most frequently associated with dental caries (p = 0.001). Only 0.9% of the teeth without enamel defects developed caries. Multivariate analyses revealed that enamel defects, night breast-feeding and poor oral hygiene habits were predictors of dental caries at 18 and 24 months (p < 0.05). Considering the risk factors evaluated at 30 months of age, the presence of enamel defects was the single predictor of caries development at 36 months (p = 0.0001). Enamel defects are strongly associated with early childhood caries and, therefore, this correlation must be considered when focussing on low-socioeconomic communities.

Fatores sócio-econômicos relacionados ao risco nutricional e sua associação com a freqüência de defeitos do esmalte em crianças da cidade de João Pessoa, Paraíba, Brasil

This study focused on factors related to nutritional risk in children over one year of age from low-income families in João Pessoa, Paraíba State, Northeast Brazil, and the frequency of related enamel defects. The study included 117 children, 56 at nutritional risk and 61 with normal growth. Nutritional evaluation, clinical dental examination, and interviews with mothers were conducted at the homes. Gestational and birth records were examined in the maternity hospital. Data were analyzed using the chi-square, Fishers exact tests, and logistic regression. Enamel defects were associated with nutritional risk after the first year of life. Nutritional risk was associated with per capita family income, birth weight, and intrauterine growth index. These are relevant factors for individual nutritional planning and formation of dental enamel.

Dentin reactions to caries are misinterpreted by histological “gold standards”

Dentin reactions to caries, crucial for pathogenesis and for the determination of the severity of caries lesions, are believed to be reasonably detected by stereomicroscopy (SM) and polarized light microscopy in quinoline (PLMQ), but accuracies are not available. Here, stereomicroscopy of wet (SW) and dry (SD) ground sections of natural occlusal caries lesions resulted in moderate (0.7, for normal dentin) and low accuracies (< 0.6, for carious and sclerotic dentin) as validated by contrast-corrected microradiography. Accuracies of PLMQ were moderate for both normal (0.71) and carious dentin (0.71). The hypothesis that detection of dentin reactions by SM and PLMQ would be influenced by the contrast quality of micrographic images was rejected. Dentin reactions were scored by SW, SD, PLMQ, and three types of microradiographic images with varying contrast qualities and each technique was compared against the one that resulted in the highest number of scores for each dentin reaction. Large differences resulted, mainly related to the detection of sclerotic dentin by both SW and SD, and normal and carious dentin by PLMQ. It is concluded that contrast-corrected microradiography should be preferred as the gold standard and SM and PLMQ should be avoided, but the relationship of PLMQ with dentin mineralization deserves further investigation.