A Controlled Study of Risk Factors for Enamel Hypoplasia in the Permanent Dentition.

Department of Pediatric Dentistry
Resident’s Name: Jessica Wilson

Article title: A Controlled Study of Risk Factors for Enamel Hypoplasia in the Permanent Dentition.

Author(s): Ford et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31(5). 382-388.

Major topic: Enamel Hypoplasia

Overview of method of research: Scientific Article

Background:
EH is thought to be caused by disruptions of enamel formation in the earlier stages of amelogenesis while EO occurs during the later stages. Medical conditions such as cystic fibrosis and congenital cardiac or liver conditions as well as infections are thought to affect ameloblast function. Chemicals such as fluoride, lead, anticancer agents and tetracycline are also thought to be etiologic agents of DDE.

Purpose:
To investigate the acquired risk factors of enamel hypoplasia (EH) and enamel opacities (EO) in permanent dentition of healthy Australian children from a non-fluoridated community.

Methods:
The population of children used was from one of the lowest socioeconomic districts in the state. 1,329 schoolchildren were examined by four calibrated pediatric dentists. The teeth were brushed, air-dried and scored using the modified DDE index (developmental defects of enamel). The first 52 boys and 52 girls in full permanent dentition with at least one tooth showing EH formed the EH group (104 children total). A similar group with only EO formed the EO group and a third control group was comprised of 105 children with no visible enamel defects.
One examiner who was blind to the clinical exams interviewed the parents/guardians regarding the child’s familial, social, medical, dental and fluoride histories and SES was evaluated by parental occupation and family income and the data was analyzed.

Findings:
Low SES, respiratory infections, exposure to cigarette smoking (especially by people other than the mother in 0-3yr olds), asthma, otitis media, UTI and chickenpox were all statistically significant for their association with EH. The combinations of chickenpox and UTI as well as chickenpox and exposure to cigarette smoking were also associated to high levels of EH.
There was less EO in children who used children’s toothpaste (300 ppm fluoride) and those who consumed optimally fluoridated water than those who did not. However, children who used adult toothpaste (1,000 ppm fluoride) from the aged 0-3yr were at a higher risk for EO.

Key points/Summary:
Children with low SES, histories of respiratory infections, exposure to cigarette smoking, asthma, otitis media, UTI, chickenpox and the use of adult toothpaste are predisposed to DDE.
Drinking optimally fluoridated water from 0-3yr can reduce the risk of DDE.

Assessment of Article:
I actually really liked this article. I liked that they evaluated EH and EO separately and since most of the permanent dentition had erupted relatively recently, there is less of a chance of caries playing a role in the defects. I thought the effect that the exposure to cigarette smoke had on the permanent dentition was very interesting. As always, further research to be done!