Underdiagnosis of enamel defects in Family Health Centres of Talca city, Chile.

Carla Orellana-Herrera; Karla Bascuñan-Yañez; Karla Gambetta-Tessini; Vidal Pérez-Valdés

doi:10.17126/joralres.2020.036

Carla Orellana-Herrera Department of Pediatric Stomatology, University of Talca, Chile.
Karla Bascuñan-Yañez Department of Pediatric Stomatology, University of Talca, Chile.
Karla Gambetta-Tessini Department of Oral Rehabilitation, University of Talca, Chile.
Vidal Pérez-Valdés Department of Pediatric Stomatology, University of Talca, Chile

DOI: https://doi.org/10.17126/joralres.2020.036

Abstract

Enamel defects (i.e. hypoplasia, diffuse and demarcated opacities), in particular Molar Incisor Hypomineralization (MIH), are alterations of dental enamel with underlying implications in affected children. A proper diagnosis and clinical dental records are needed to improve clinical management of enamel defects in primary health setting. This cross-sectional study aimed to determine the prevalence of enamel defects in 6-year-old children attending to Family Health Centres in Talca city and comparing the clinical diagnosis with that registered by general dental practitioners (GDPs) on the clinical dental records. Children (n=318) were evaluated by a calibrated examiner using the modified DDE index criteria. Almost half of children had enamel defects (47.5%; n=151). The proportion of children affected by demarcated opacities (36.8%; n=117) was higher than those effected by hypoplasia (13.8%; n=44) and diffuse opacities (12.6%; n=40). MIH prevalence was 19.8% (n=63) and 22% (n=14) of MIH-affected children presented the severe form. Clinical dental records registered by GDPs recorded 6.6% (n=10) of enamel defects, but the type of defect was not consistent with the clinical examination undertaken by the calibrated examiner. These findings suggest that enamel defects are prevalent in the studied population, but only few cases were registered in clinical dental records. To achieve diagnosis consensus, the registration section for enamel defects in the clinical dental record at Family Health Centres may need some improvement. Further diagnostic training for GDPs working in the public sector may also be necessary.

References

1. Hubbard MJ, Mangum JE, Perez VA, Nervo GJ, Hall RK. Molar Hypomineralisation: A Call to Arms for Enamel Researchers. Front Physiol. 2017;8:546.
2. Orellana C, Perez V. Modified glass ionomer and orthodontic band: An interim alternative for the treatment of molar incisor hypominerlaization. A case report. J Oral Res. 2017;6(3):70-4.
3. Almuallem Z, Busuttil-Naudi A. Molar incisor hypomineralisation (MIH) - an overview. Br Dent J. 2018;225:601-9.
4. Lacruz RS, Habelitz S, Wright JT, Paine ML. Dental enamel formation and implications for oral health and disease. Physiol Rev. 2017;97(3):939-93.
5. Suckling GW. Developmental defects of enamel--historical and present-day perspectives of their pathogenesis. Adv Dent Res. 1989;3(2):87-94.
6. Barros de Alencar C, Cavalcanti A. Molar incisor hypomineralization - A challenge of Pediatric Dentistry ? J Oral Res. 2018;7(3):84-5.
7. Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35(5):390-1.
8. Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization - A systematic review. Community Dent Oral Epidemiol. 2016;44(4):342-53.
9. Gambetta-Tessini K, Marino R, Ghanim A, Calache H, Manton DJ. The impact of MIH/HSPM on the carious lesion severity of schoolchildren from Talca, Chile. Eur Arch Paediatr Dent. 2019;20(5):417-23.
10. Corral-Núñez C, Rodríguez H, Cabello R, Bersezio-Miranda C, Cordeiro RCL, Fresno-Rivas MC. Impacto de la hipomineralización incisivo molar en la experiencia de caries en escolares de 6-12 años en Santiago, Chile. Rev Clin Periodoncia Implantol Rehab. 2016;9:277-83.
11. Jans Muñoz A, Díaz Meléndez J, Vergara González C, Zaror Sánchez C. Frecuencia y Severidad de la Hipomineralización Molar Incisal en Pacientes Atendidos en las Clínicas Odontológicas de la Universidad de La Frontera, Chile. Int j Odontostomatol. 2011;5:133-40.
12. Almuallem Z, Busuttil-Naudi A. Molar incisor hypomineralisation (MIH) - an overview. Br Dent J. 2018; 225:601-9.
13. Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH). Eur Arch Paediatr Dent.2010;11(2):75-81.
14. Eichenberger M, Erb J, Zwahlen M, Schätzle M. The timing of extraction of non-restorable first permanent molars: a systematic review. Eur J Paediatr Dent. 2015;16(4):272-8.
15. Elfrink ME, Ghanim A, Manton DJ, Weerheijm KL. Standardised studies on Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM): a need. Eur Arch Paediatr Dent. 2015;16(3):247-55.
16. Superintendencia-de-salud. Garantías Explícitas en Salud (GES) [Internet]. Santiago: Superintendencia de Salud; 2019 [cited 2020 May 23]. Available at: http://www.supersalud.gob.cl/difusion/665/w3-article-597.html.
17. MINSAL. Guia Clínica Urgencias odontologicas [Internet]. Santiago: Ministerio de Salud; 2011 [cited 2020 May 23]. Available from https://www.minsal.cl/portal/url/item/7222b6448161ecb1e04001011f013f94.pdf.
18. Gambetta-Tessini K, Mariño R, Ghanim A, Calache H, Manton DJ. Knowledge, experience and perceptions regarding Molar-Incisor Hypomineralisation (MIH) amongst Australian and Chilean public oral health care practitioners. BMC Oral Health. 2016;16(1):75.
19. Gambetta-Tessini K, Mariño R, Ghanim A, Calache H, Manton D. Carious lesion severity and demarcated hypomineralized lesions of tooth enamel in schoolchildren from Melbourne, Australia. Aus Dent J. 2018;63(3):365-73.
20. A review of the developmental defects of enamel index (DDE Index). Commission on Oral Health, Research & Epidemiology. Report of an FDI Working Group. Int Dent J. 1992;42(6):411-26.
21. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
22. Andrade NS, Dos Santos IT, Lima LMS, Lima CCB, Moura LFAD, Barros SSLV, Moura MS, Lima MDM. Impact of Developmental enamel defects on quality of life in 5-year-old children. Int J Paediatr Dent. 2019;29(5):557-565.
23. Opydo-Szymaczeka J, Gerreth K, Borysewicz-Lewicka M, Pawlaczyk-Kamieńska T, Torlińska-Walkowiak N, Śniatała R. Enamel defects and dental caries among children attending primary schools in Poznań, Poland. Adv Clin Exp Med. 2018;27(11):1535-40.
24. Glodkowska N, Emerich K. Molar Incisor Hypo-mineralization: prevalence and severity among children from Nothern Poland. Eur J Paediatr Dent. 2019;20(1):59-66.
25. Ghanim A, Mariño R, Manton DJ. Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index. Int J Paediatr Dent. 2019;29(1):6-13.
26. Dabiri D, Eckert GJ, Li Y, Seow K, Schroth RJ, Warren J, Wright JT, Zhao S, Fontana M. Diagnosing Developmental Defects of Enamel: Pilot Study of Online Training and Accuracy. Pediatr Dent. 2018;40(2):105-109.
27. Jälevik B, Szigyarto-Matei A, Robertson A. Difficulties in identifying developmental defects of the enamel: a BITA study. Eur Arch Paediatr Dent. 2019; 20(5):481-88.
28. Ghanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Mariño RJ, Weerheijm KL, Manton DJ. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent. 2017;18(4):225-42.
29. Ghanim A, Elfrink M, Weerheijm K, Mariño R, Manton D. A practical method for use in epidemiological studies on enamel hypomineralisation. Eur Arch Paediatric Dent. 2015;16(3):235-46.