Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren.
Molar incisor hypomineralisation (MIH) resulting from developmental qualitative disturbance of tooth enamel is commonly encountered in clinical practice and presents challenging problems of compromised aesthetics, tooth sensitivity, and caries susceptibility [Weerheijm et al., 2003; Jalevik, 2010; Ghanim et al., 2011a]. This developmental defect of enamel often affects one to four first permanent molars, with or without involvement of the permanent incisors [Weerheijm et al., 2003]. It is the consequence of insults to the highly specialised and vulnerable ameloblast cells, apparently during the later mineralisation phase of amelogenesis resulting in defective enamel with significantly increased protein content [Farah et al., 2010; Mangum et al., 2010]. Clinically, MIH presents with a spectrum of severity ranging from alteration in enamel translucency and varying in degree from creamy-white to yellow-brown demarcated opacities, to deficiencies in enamel substance following tooth eruption (known as post-eruptive enamel breakdown) [Weerheijm et al., 2003].
The prevalence of MIH is variable worldwide but may be increasing [Weerheijm, 2004]. In a broader part of the present study which investigated the prevalence of MIH in the permanent dentition amongst school-aged Iraqi children, 18.6% of the surveyed children were found to be affected with MIH. Creamy white opacities were the most frequent type of defect, and the more severe the lesion the greater was the involved tooth surface area [Ghanim et al., 2011b].
Environmental conditions thought to affect ameloblast function range from ill-health during pregnancy to perinatal medical conditions such as premature birth and low birth weight to early childhood acute illnesses including pneumonia and unexplained high fever [Chawla et al., 2008; Arrow, 2009; Alaluusua, 2010]. Various environmental chemicals, including dioxin, bisphenol A and drugs such as asthma medications and amoxicillin have also been identified as contributing to or causing MIH [Alaluusua et al., 1996; Whatling and Fearne, 2008; Wogelius et al., 2010]. Whilst the role of fluoride in preventing dental caries is well recognised, its role in the aetiology of demarcated hypomineralisation lesions is perplexing. Some authors suggested that intracellular changes in fluoride ion concentration could alter the threshold of the ameloblast to form defective enamel; however this suggestion has not been confirmed [Balmer et al., 2005]. However the same authors reported that fluoride has a protective effect against the development of demarcated lesions [Balmer et al., 2011].
Optimal dental health can be obtained when appropriate oral hygiene practices and dental behaviours are maintained in conjunction with a low cariogenic diet in the presence of adequate saliva. Individual oral health care mainly involves daily oral hygiene practices, including tooth brushing and flossing, and regular cleaning and care at the dental office [Abegg et al., 2000; Attin and Hornecker, 2005]. When a tooth has a defect it is often difficult to clean it. Poor daily oral care could not just worsen the clinical status of a defective tooth, but could also have a negative impact on the remaining sound tooth structure leading to increased treatment needs. It is recognised that MIH predisposes an affected tooth surface to plaque accumulation, sensitivity, and may contribute to dental caries development [da Costa-Silva et al., 2010; Lygidakis et al., 2010]. Information about the impact of MIH on the oral health care of the affected individuals is, however, lacking.
The aims of the present study were to describe and compare individual oral health care practices between MIH-affected and non-affected children. To evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars. To explore the role of reported fluoride exposure in the development of MIH.
Materials and methods
Population sample. The data used in this study were collected between October 2009 to June 2010, as part of a larger cross-sectional study investigating MIH-prevalence, severity and aetiological factors in 7-9 year-old primary school children in Mosul City, Iraq. Ethical approvals from the Human Research Ethics Committee of the University of Melbourne and the Dental College of Mosul University were obtained. Permission was obtained from the Education Department of the Nineveh Governorate and from schools' directors. A total of 823 of 1,000 subjects had parents/guardians given informed consent and participated in the study (response rate 82.3%) [Ghanim et al., 2011b]. The study included a clinical examination for the children, a systemic health questionnaire-based interview and a self-answered structured questionnaire for each child's mother that will be explained later. The natural concentration of fluoride in the reticulated water supply of the community has been recorded as below 0.19 [+ or ] 0.07 ppm F [Al-Dahan and Al-Rawi, 2006].
Survey instrument. Based on an Australian study [Chawla et al., 2008]; a self-answered structured questionnaire was developed to compare the oral health activities of MIH-affected subjects with the non-affected counterparts. Sixteen questions were developed regarding history of dental visits, fluoride intake and the pattern of oral hygiene practices from early childhood (i.e. one year-old) up to the time this study was conducted. The questions were validated in terms of applicability and repeatability prior to the study. Assessment of the relevant oral health components (via multiple choice questions) included the following:
* Biographic variables: child's age of first dental visit; reason/s for first dental visit; frequency of seeking dental care.
* Fluoride exposure variables: systemic exposure to fluoride (i.e. community water fluoridation); use of topical fluoride other than toothpaste such as chewed tablets, gel application, mouth rinse (professional and/or personal application); age started using toothpaste; type of fluoridated toothpaste; amount of applied toothpaste; toothpaste swallowing tendency.
* Oral hygiene practice variables: age at which parents started brushing their child's teeth, age at which child's started brushing his/her own teeth; frequency of brushing when first started, and at present; brushing supervision.
A questionnaire was constructed in English, translated into Arabic, and back-translated into English to confirm content. Each mother was asked to complete the questionnaire administered at the school in the presence of the principal investigator (AG). On completing the questionnaire clinical examinations were performed by AG with the aid of an assistant to record the observations on data sheets provided for that purpose. The sampling included similar numbers in each age and gender group. Participating children were given a toothbrush and fluoridated toothpaste to brush their teeth thoroughly. First permanent molars and incisor teeth were examined for the presence of MIH [Ghanim et al., 2011b]. The EAPD evaluation criteria were used to identify MIH-characteristic hypomineralisation including demarcated opacities, post-eruptive enamel loss, atypical restorations and missing tooth presumably due to demarcated lesions [Weerheijm et al., 2003]. The grade of hypomineralisation for each individual tooth was classified by the most severe defect observed on its surface. The clinical examination also included a full mouth caries assessment following the International Caries Detection and Assessment System for a sub group of children [ICDAS II, 2005; Ghanim et al., 2012].
A number of clinical measures to assess dental treatment needs were included: a) teeth that had apparently sound restorations or diagnosed as caries-free were categorised under "no dental treatment required/require primary prevention", b) teeth diagnosed with caries lesions in enamel and/ or dentine, teeth with a broken restoration or restoration with secondary caries at the margins were categorised under "require restoration", c) extracted and badly broken down teeth that could not be restored were categorised under "require extraction and/or space closure".
Data analysis. In order to compare variables distribution the sample was dichotomised into two categories: those diagnosed with MIH (referred to as 'MIH-affected group'; n=153) and those who were non-MIH-affected (control; n=670). Previous analysis also reported about 72% of the total affected group were diagnosed with demarcated opacities, distributed as (39.8% with creamy white opacities and 32% with yellow brown opacities), post-eruptive enamel breakdown, atypical restoration and tooth missing due to MIH were found in 28% [Ghanim et al., 2011b]. Binary logistic regression analysis was performed to determine differences between the study groups by oral hygiene practices, dental visits and to assess whether exposure to fluoride has a role in MIH occurrence. Three models were fitted with three different sets of explanatory variables. These were biographic variables (grouped into four categories), fluoride exposure variables (grouped into three categories) and oral hygiene practice variables (grouped into eight categories). All explanatory variables in the set were used in the model (so-called "enter method") and reported on each of the three full models. In the individual model, each variable was considered as a potential confounder and the data was analysed with and without controlling for the potential confounder. To compare dental treatment requirements for first permanent molars, from the total group of MIH-affected children, a sample subset was drawn (n=100) who had their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System [ICDAS II 2005, Ghanim et al., 2012]. This sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. Chi-square ([chi square]) statistics were used for testing the relationship between MIH severity and tooth brushing frequency and for assessing differences in the treatment required between hypomineralised and non-hypomineralised first molars. Differences at an alpha level < 0.05 were considered statistically significant. Data were coded and entered into SPSS (ver. 18.0; SPSS Inc, Chicago, IL, USA).
Population sample distribution by biographic variables. The distributions and differences between the study groups by history of dental visits and fluoride exposure variables are presented in Table 1. In both groups, the majority of parents (70.8%) indicated that they had taken their children to the dentist at some time. When the two groups were compared, the MIH-affected group reported a higher frequency of attendance compared with their non-affected peers (82.4% vs 68.2%, respectively) ([chi square](1) = 12.1, p<0.001). The most likely causes for seeking dental care at the first dental appointment was "other reasons such as tooth filling or extraction" (57.9%) for both groups. When mothers were asked about the frequency of visiting a dentist, "once every three months" was the most reported response for the MIH-affected group (72.8%), whereas "once a year" was the most common response among the non-affected group (55.8%).
Logistic regression analysis was performed to compare study groups by biographic variables. The test of the model with its four predictors was statistically significant ([chi square](7) = 127.7, p<0.001), indicating that the predictors, as a set, reliably distinguished between MIH-affected and non-affected subjects. Nagelkerke's R2, an indicator of the goodness-of-fit of the model, was 30.6%. After controlling for the other independent variables included in the model, children displaying the defect were over three times more likely to visit the dentist complaining of pain and were over six times more likely to seek dental care due to tooth sensitivity than were their non-affected counterparts (OR = 3.18, 95% CI 1.27-7.95; OR = 6.37, 95% CI 1.64-24.71; respectively).
Population sample distribution by fluoride exposure variables. The distributions and differences between the study groups by fluoride exposure variable are presented in Table 1. Tap water was the main source of water consumed at home by the majority of children (77.8%). Early consumption of fluoridated water and exposure to different sources of topical fluoride was noted by only a minority of respondents (18.9%, 21.2%; respectively) and therefore was not statistically evaluated. Modeling of variables for type of water consumed at home and for a positive history of exposure to fluoridated water revealed a statistical significant relationship with MIH occurrence, ([chi square] (2) = 10.1, p<0.01). After controlling for other variables present in the model, exposure to fluoridated water up to the age of three years appeared to have a protective effect for MIH (OR = 0.38; 95% CI 0.20-0.73). Nagelkerke's [R.sup.2], an indicator of the goodness-of-fit of the model, was 2%.
Population sample distribution by oral hygiene practice variables. The distribution and difference between the study groups when compared by tooth brushing and toothpaste history are presented in Table 2. Most parents in both study groups commenced brushing their child's teeth after three years of age (63.9%). Most children had commenced brushing on their own between 4-6 years of age (59.9%). Brushing supervision "on occasion" was the most frequently chosen option (48%). The initial daily frequency of tooth brushing as well as when the children were older was at least once-a-day (76.2%, 58.7%, respectively). A pea-sized amount of toothpaste was claimed to be used by 29% of the children, and children's toothpaste was most commonly used by both groups (30.3%). To test differences between study groups regarding brushing and toothpaste history, a logistic regression model was used. The test for this model with its eight predictors did not reach statistical significance ([chi square] (32) = 12.4, p>0.05).
Defect clinical presentation and daily tooth brushing frequency. The distribution of the affected subjects in terms of lesion severity and brushing frequency per day is presented in Table 3. Analysis of the possible relationship between MIH severity and brushing frequency did not reach statistical significance. However, the frequency of brushing decreased remarkably with the increase in lesion severity. Non-brushing was approximately twice as common in children with post-eruptive enamel breakdown/ atypical restoration than in children with creamy white opacities.
Tooth sample distribution by dental caries status and dental treatment required. The distribution of dental caries experience and dental treatment required in a sample subset of hypomineralised and non-hypomineralised molars is presented in Table 4. Non-hypomineralised molars were over three times more caries-free than the hypomineralised ones (66.3% vs. 20.0%, respectively). The prevalence of dental caries and tooth restorations was higher in hypomineralised molars (78.5%) than in the defect-free molars (33.7%). No broken restorations (normal or atypical) or secondary caries were observed. The two molars missing in the sample had been extracted due to demarcated lesions. A significant difference existed between hypomineralised and non-hypomineralised molars when assessing their dental caries status ([chi square] (2) = 77.28, p<0.001). With regard to required dental treatment, 21.5% of the hypomineralised molars did not require treatment compared with 74% of the non-hypomineralised molars. Over half of the affected molars required restorative intervention compared withh 23.7% of the defect-free molars. Extraction and orthodontic intervention was deemed necessary for 16.2% of the hypomineralised molars compared with only 2.2% for their non-affected counterparts. Assessment of the total dental treatment required revealed a highly significant difference between hypomineralised and non-hypomineralised molars ([chi square] (2) = 99.84, p<0.001).
The present study derived its sample from public primary schools and therefore included children from different socioeconomic backgrounds. The high rate of primary school attendance at various socio-economic levels of students in public schools in Iraq [Iraq Education Sector Scoping Study, 2009] supports the representativeness of the sample for the Iraqi children in this age group. All parents appeared to be dentally aware, commenced cleaning their children's teeth in early childhood, occasionally assisting or supervising tooth brushing with age-appropriate strength fluoride toothpastes delivered in appropriate amounts. Although it appears that MIH lesions have no role on brushing frequency as tooth cleaning "once-a-day" was the most common self-reported practice in both study groups and the relationship between the defect severity and brushing frequency in the affected children was not statistically significant, lesion severity appears to play a role. There was a considerable reduction in the cleaning frequency with increased lesion severity supporting the evidence from past literature on tooth pain and sensitivity as detrimental outcomes of severe lesions [Weerheijm et al., 2001; Kotsanos et al., 2005]. In the non-MIH subjects, the yearly dental visits could be attributed to the absence of clinical complaint in those children particularly when compared with their affected counterparts who sought dental consultation every three months. The increased treatment need amongst the affected children confirmed the burden caused by this defect for both children and their parents, and is in agreement with previous findings [Jalevik and Klingberg, 2002; Chawla et al., 2008].
In a conjoint study comparing dental caries status between MIH-affected and non-affected children, the mean caries index scores (DMFT) in the affected subjects was double that of their counterparts [Ghanim et al., 2012]. In the present results, the deteriorating dental health status and increased treatment demands for those subjects with hypomineralised teeth support previous study findings and confirmed that demarcated hypomineralised defect is a prominent caries risk factor [Elfrink et al., 2010; Nelson et al., 2010]. In previous research studies, dental caries status was compared between affected and non-affected study groups [Leppaniemi et al., 2001; Muratbegovic et al., 2007; da Costa-Silva et al., 2010], and information on the dental treatment performed rather than treatment required was reported [Jalevik and Klingberg, 2002; Chawla et al., 2008]. In study, dental treatment was assessed prospectively and non-affected teeth selected from subjects diagnosed with demarcated lesions to control for possible confounding factors, such as individual dietary habits and salivary characteristics, and to highlight the effect of MIH as the key factor in deteriorating tooth health status. With the weakened physical properties of hypomineralised enamel, lesions will rapidly progress if high caries challenge is superimposed, resulting in greater ongoing need for dental care.
The lack of exposure to fluoride, whether systemically or as supplementation, would suggest it was unlikely that the mild hypomineralisation defects, distinctive MIH-clinical presentations diagnosed in the study group, were fluorotic lesions. However, the findings of exposure to topical fluoride should be considered with caution as the response rate to this question in both groups was relatively low (40.6%). On the other hand, exposure to fluoridated water during early childhood was reported by a minority of the sample of whom the majority was represented by non-affected children. Therefore, consistent with a recent study [Whatling and Fearne, 2008], it is highly unlikely that fluoride is a potential causative factor of MIH. Surprisingly, the analyses showed that exposure to fluoride up to the first three years of life seemed to be protective against MIH, in agreement with a recent UK study [Balmer et al., 2011]. This supports the notion that early exposure to fluoride could increase the resistance of enamel to defect development [Cutress et al., 1985; Balmer et al., 2005]. However, the result should be treated with caution as it is based on self-reported information and the concentration of the fluoride in the bottled water was unknown. In addition, only a few MIH-cases reported early fluoride exposure and the percentage of the variance accounted for by early exposure to fluoride in the full model was remarkably low.
Clinical data collected in the present study showed that a higher proportion of unmet restorative need was most frequently observed in the MIH-affected group. Follow-up and recall programs are essential to ensure that unmet needs are addressed. For example, a screening program by trained oral health personnel could be established which allows for early detection, treatment and opportunities for referral.
It was noted that the predictive power of the multiple regression models was not large (between 2% and 30% of the variance), indicating a need for future research in this area to identify additional predictors. Given differences in the predictive power of clinical and subjective indicators, future dental health care assessment can be better achieved by conducting longitudinal prospective studies. These studies should include both professionally determined clinical parameters as well as subjective indicators, such as accurate indicators of caries risk and dental health knowledge. Improved prediction could increase the capacity of dental health services to respond to oral health treatment needs in young populations diagnosed with MIH.
The present results need to be considered within the limitations of the study design. The questions in the survey were designed to be as simple and clear as possible, however, some questions reported low response rates which could be in part attributed to recall difficulties or trouble understanding the question. The most obvious shortcoming is the potential for recall bias in asking the mother to self-report retrospectively on her child's dental health history. In addition several variables were not investigated comprehensively. For example the frequency of mouth rinsing after meals, the quality of brushing and flossing practices were not determined, and the findings are restricted to a sub-group of the Iraqi community. Nonetheless, for this and other communities, the results can serve as an impetus for further emphasis of the importance of early intervention to prevent or ameliorate progression of defects and reduce the dental treatment need. From a public health perspective, the present study provides the necessary evidence for future introduction of promotion oral health programs under Iraqi conditions.
This is the first study to assess oral care patterns in relation to demarcated hypomineralisation lesions. MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts. They were over three times more likely to visit the dentist due to complaining of tooth sensitivity and pain than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" commonly reported in both groups. Hypomineralised molars required more the twice the amount of restorative care than unaffected molars.
We are grateful to all the children and their mothers for participating in the study and the school principals for their cooperation in performing this study. Special thanks to Professor Alsandook and Dr Alnuaimi for their support and assistance when collecting data. We should like to acknowledge Dr Chawla and her co-authors' contribution of the oral health questionnaire used in the Australian study. The support of the Oral Health CRC, the University of Melbourne and the Education Department of the Nineveh Governorate is acknowledged with gratitude.
Abegg C, Croucher R, Marcenes WS, Sheiham A. How do routines of daily activities and flexibility of daily activities affect tooth-cleaning behavior? J Public Health Dent 2000; 60: 154-158.
Alaluusua S, Lukinmaa PL, Vartiainen T et al. Polychlorinated dibenzo-pdioxins and dibenzofurans via mother's milk may cause developmental defects in the child's teeth. Environ Toxicol Pharmacol 1996; 1: 193-197.
Alaluusua S. Aetiology of Molar-Incisor Hypomineralisation: A systematic review. Eur Arch Paediatr Dent 2010; 11: 53-58.
Al-Dahan ZA, Al-Rawi BA. Determination of fluoride, zinc and lead ions concentrations in primary teeth and drinking water and dental caries experience. Al-Rafidain Dent J 2006; 6(Spec Iss): 23-29.
Arrow P. Risk factors in the occurrence of enamel defects of the first permanent molars among schoolchildren in Western Australia. Community Dent Oral Epidemiol 2009; 7: 405-415.
Attin T, Hornecker E. Tooth brushing and oral health: how frequently and when should tooth brushing be performed? Oral Health Prev Dent 2005; 3: 135-140.
Balmer RC, Laskey D, Mahoney E, Toumba KJ. Prevalence of enamel defects and MIH in non-fluoridated and fluoridated communities. Eur J Paediatr Dent 2005; 6: 209-212.
Balmer R, Toumba J, Godson J, Duggal M. The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation. Int J Paediatr Dent 2011;doi: 10.1111/j.1365-263X.2011.01189.x.
Chawla N, Messer LB, Silva M. Clinical studies in molar incisor hypomineralisation. Part I: Distribution and putative associations. Eur Arch Paediatr Dent 2008; 9: 180-190.
Cutress TW, Suckling GW, Pearce EIF, Ball ME. Defects of tooth enamel in children in fluoridated and non-fluoridated water areas of the Auckland region. N Z Dent J 1985; 81: 12-19.
da Costa-Silva CM, Jeremias F, de Souza JF et al. Molar incisor hypomineralization: prevalence, severity and clinical consequences in Brazilian children. Int J Paediatr Dent 2010; 20: 426-434.
Elfrink ME, Schuller AA, Veerkamp JS et al. Factors increasing the caries risk of second primary molars in 5-year-old Dutch children. Int J Paediatr Dent 2010; 20: 151-157.
Farah RA, Swain MV, Drummond BK, Cook R, Atich M. Mineral dentisity of hypomineralized enamel. J Dent 2010; 38: 50-58.
Ghanim A, Morgan M, Marino R, Manton D, Bailey D. Perception of Molar-Incisor Hypomineralisation (MIH) by Iraqi Dental Academics. Int J Paediatr Dent 2011a; 21: 261-270.
Ghanim A, Morgan M, Marino R, Manton D, Bailey D. Molar-incisor hypomineralisation: prevalence and defect characteristics in Iraqi children. Int J Paediatr Dent 2011b; 21: 413-421.
Ghanim A, Morgan M, Marino R, Bailey D, Manton D: "An in vivo investigation of salivary properties, enamel hypomineralisation and carious lesion severity in a group of Iraqi schoolchildren". Int J Paediatr Dent 2012; DOI: 10.1111/j.1365-263X.2011.01215.x.
International Caries Detection and Assessment System (ICDAS II). Criteria Manual Appendix. Workshop held in Baltimore, Maryland, March 12th-14th 2005. Sponsored by the National Institute of Dental and Craniofacial Research, the American Dental Association, and the International Association for Dental Research. www.dundee.ac.uk/dhsru/docs/Rationale%20and%20 Evidence%20ICDAS%20II%20Septemb.
Iraq Education Sector Scoping Study--Geopolicity, 2009. Available at: www. geopolicity.com/upload/content/pub_1288013876_regular.pdf.
Jalevik B, Klingberg G. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent 2002; 12: 24-32.
Jalevik B. Prevalence and Diagnosis of Molar-Incisor-Hypomineralisation (MIH): A systematic review. Eur Arch Paediatr Dent 2010; 11: 59-64.
Kotsanos N, Kaklamanos EG, Arapostathis K. Treatment management ofFPMs in children with molar incisor hypomineralisation. Eur J Paediatr Dent 2005; 6: 179-184.
Leppaniemi A, Lukinmaa PL, Alaluusua S. Nonfluoride hypomineralizations in the permanent first molars and their impact on the treatment need. Caries Res 2001; 35: 36-40.
Lygidakis NA, Wong F, Jalevik Bet al. Best clinical practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document. Eur Arch Paediatr Dent 2010; 11: 75-81.
Mangum JE, Crombie FA, Kilpatrick N, Manton DJ, Hubbard MJ. Surface integrity governs the proteome of hypomineralized enamel. J Dent Res 2010; 89: 1160-1165.
Muratbegovic A, Marcovic M, Ganibegovic Selmovic M. Molar Incisor Hypomineralisation in Bosnia and Herzegovina: prevalence, aetiology and clinical consequences in medium caries activity population. Eur J Paediatr Dent 2007; 8: 189-194.
Nelson S, Albert JM, Lombardi G et al. Dental caries and enamel defects in very low birth weight adolescents. Caries Res 2010; 44: 509-518.
Weerheijm KL, Jalevik B, Alaluusua S. Molar-Incisor Hypomineralisation. Caries Res 2001; 35: 390-391.
Weerheijm K, Duggal M, Mejare I et al. Judgement criteria for molar-incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent 2003; 4: 110-113.
Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update, 2004; 31: 9-12.
Whatling R, Fearne JM. Molar incisor hypomineralization: a study of aetiological factors in a group of UK children. Int J Paediatr Dent 2008; 18: 155-234.
Wogelius P, Haubek D, Nechifor A et al. Association between use of asthma drugs and prevalence of demarcated opacities in permanent first molars in 6-to-8-year-old Danish children. Community Dent Oral Epidemiol 2010; 38: 145-151.
A.M. Ghanim, D.J. Manton, M.V. Morgan, R.J. Marino, D.L. Bailey. Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville Victoria, Australia.
Postal address: Dr A. Ghanim, Population Oral Health & Periodontics, Melbourne Dental School, The University of Melbourne, Victoria, 3010 Australia.
Table 1. Frequency distribution of MIH-affected and non-affected Iraqi children by dental visits and fluoride exposure variables * MIH-affected Non-MIH affected Biographic factors (N=153) N (%) (N=670) N (%) Child's visit to the dentist Yes 126 (82.4) 457 (68.2) No 27 (17.6) 213 (31.8) Total 153 670 Age (years) at first dental visit 1-3 36 (28.6) 116 (25.3) 4-6 66 (52.4) 239 (52.1) 7-9 24 (19.0) 104 (22.7) Total 126 459 Reason for first dental appointment For a check-up 8 (6.5) 46 (10.0) Child's teeth "didn't look right" 6 (4.8) 46 (10.0) ** Child complained of pain 42 (33.9) 78 (17.0) (sudden, sharp or shooting ache). *** Child complained of sensitivity 10 (8.1) 9 (2.0) Other (e.g. tooth restoration, 58 (46.8) 279 (60.9) extraction) Total 124 458 Frequency of dental visits at present Once every 3 months 91 (72.8) 149 (32.5) Once every 6 months 13 (10.4) 34 (7.4) Once a year 11 (8.8) 256 (55.8) Other (e.g. when there is a 10 (8.0) 20 (4.4) problem) Total 125 459 Type of water consumed at home at present Tap water (non-fluoridated) 119 (77.8) 520 (77.8) Bottled water (fluoridated) 34 (22.2) 148 (22.2) Total 153 668 Use of fluoridated water up to age 3 years No 142 (92.8) 554 (83.3) ([dagger]) Yes 11 (7.2) 111 (16.7) Total 153 665 Use of topical fluoride other than toothpaste up to age 3 years No 37 (82.2) 226 (78.2) Yes 8 (17.8) 63 (21.8) Total 45 289 * Numbers of the groups may not add to their totals due to missing values. ** A significant predictor distinguishing between MIH-affected and non-affected subjects at p=0.007, (from the logistic regression model). *** A significant predictor distinguishing between MIH-affected and non-affected subjects at p=0.013, (from the logistic regression model). ([dagger]) A significant protective effect at p=0.004, (from the logistic regression model). MIH: Molar-incisor hypomineralisation. Table 2. Frequency distribution of MIH-affected and non-affected Iraqi children by tooth brushing and toothpaste history * Tooth brushing and MIH-affected Non-MIH affected toothpaste history (N=153) N (%) (N=670) N (%) Age (years) when parent started brush child's teeth 0-1 3 (2.0) 8 (1.2) 1-2 12 (7.8) 43 (6.4) 2-3 39 (25.5) 147 (22.0) >3 82 (53.6) 443 (66.3) I did not brush my child's teeth 17 (11.1) 27 (4.0) Total 153 668 Age (years) when child started to brush own teeth Child still too young 9 (5.9) 37 (5.5) < 3 12 (7.8) 52 (7.8) 3-4 24 (15.7) 50 (7.4) 4-6 62 (40.5) 430 (64.3) > 6 46 (30.0) 100 (14.9) Total 153 669 Parent supervises tooth brushing at present Yes 35 (22.9) 168 (25.3) Sometimes 70 (45.8) 322 (48.6) No 48 (31.4) 173 (26.1) Total 153 663 Frequency of brushing per day when first started Not at all 13 (8.7) 20 (3.0) Once 108 (72.0) 514 (77.1) Twice 23 (15.3) 107 (16.1) More than twice 6 (4.0) 25 (3.8) Total 150 666 Frequency of brushing per day at present Not at all 40 (26.1) 97 (14.5) Once 58 (37.9) 423 (63.4) Twice 47 (30.7) 125 (18.7) More than twice 8 (5.2) 22 (3.3) Total 153 667 Fluoridated toothpaste used when first started brushing Yes, from the beginning 115 (76.2) 516 (77.4) No, only started after the age of: 2-4 years 9 (6.0) 26 (3.9) 5-8 years 27 (17.9) 112 (16.8) Total 151 654 Amount of fluoridated toothpaste used when first started I did not use toothpaste 11 (7.2) 36 (5.4) A smear along the brush 39 (25.5) 182 (27.2) Pea-size 48 (31.4) 190 (28.4) Covering half of the brush 38 (24.8) 182 (27.2) Covering the whole brush 17 (11.1) 79 (11.8) Total 153 669 Brand of fluoridated toothpaste usually used Biofresh Children's toothpaste 17 (11.3) 68 (10.2) Dentakleen Children's toothpaste 20 (13.2) 89 (13.3) Other children's toothpaste 46 (30.5) 202 (30.2) Other adult's toothpaste 33 (21.9) 144 (21.6) Not sure 35 (23.2) 165 (24.7) Total 151 668 * Numbers of the groups may not add to their totals due to missing values. MIH: Molar-incisor hypomineralisation. Table 3. Distribution of MIH-affected Iraqi children by defect type and daily tooth brushing frequency Brushing frequency Twice Once Not at Defect type N (%) N (%) all N (%) Total N White/creamy demarcated 21 (38.2) 30 (51.7) 10 (25.0) 61 opacities Yellow/brown demarcated 20 (36.4) 16 (27.6) 13 (32.5) 49 opacities Post-eruptive breakdown/ 14 (25.5) 12 (20.7) 17 (42.5) 43 Atypical restoration Total 55 58 40 153 MIH: Molar-incisor hypomineralisation Table 4. Dental caries status and dental treatment required of hypomineralised and non-hypomineralised first permanent molar in a group of Iraqi children (n=100) Hypomineralised Non-hypomineralised first molar * first molar ** N (%) N (%) Dental caries status *** Sound 26 (20.0) 179 (66.3) Decayed or restored 102 (78.5) 91(33.7) Extracted 2 (1.5) 0 Dental treatment need ([dagger]) No treatment/Prevention 28 (21.5) 200 (74.1) Restoration 81 (62.3) 63(23.7) Extraction and space closure 21(16.2) 6 (2.2) * Hypomineralised first molar (n=130). ** Non-hypomineralised first molar (n=270). *** Significant difference between hypomineralised and non-hypomineralised molars in caries experience (x2(2)=77.28, p<0.001). fSignificant difference between hypomineralised and non-hypomineralised molars in dental treatment need (x2(2)=103.79, p<0.001).
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|Author:||Ghanim, A.M.; Manton, D.J.; Morgan, M.V.; Marino, R.J.; Bailey, D.L.|
|Publication:||European Archives of Paediatric Dentistry|
|Date:||Aug 1, 2012|
|Previous Article:||Molar incisor hypomineralisation: possible aetiological factors in children from urban and rural areas.|
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