Summary:
Introduction: Developmental defects of enamel constitute a frequent finding in
primary and permanent dentition. They have been described as enamel hypoplasia
and enamel hypomineralization depending on whether the defect is quantitative
or qualitative, respectively. Systemically acting medical factors have been
identified as putative causal factors for the development of molar
hypomineralization. Asthma and the drugs used for treatment have been studied
as potential risk factors in a few studies.
Aim: Τhe aim of this study was to investigate the association between the
occurrence of enamel developmental defects, in first permanent molars, and
intake of bronchodilators and/or corticosteroids for treatment of asthma like
episodes at preschool age, in 6-14 year old Greek children.
Methods: 140 children 6-14 years old participated in a retrospective
case-control study. The study group was consisted of 70 children who were
followed in the Paediatric Pulmonary Unit and Unit of Allergology, Asthma and
Inflammation of First Department of Pediatrics of University of Athens at ’
Aghia Sofia’ Children’s Hospital, Athens, Greece and had used asthma drugs
for treatment of asthma like episodes from birth until the age of 4 years.
Seventy children who visited the Postgraduate Paediatric Dental Clinic,
University of Athens and had a medical history free of systemic diseases and
never taken asthma drugs were included in the control group. Parents of the
participating children were interviewed to provide information regarding
demographic data, medical history , pregnancy, birthing process, birth weight,
duration of breastfeeding, mother’s smoking habits and antibiotic use, from
birth until 4 years of age, by using a structured questionnaire. Data on use of
asthma drugs such as type of drug, age at onset of drug treatment and duration
of use were taken from medical records in the above units. Each participant
underwent a dental examination, where all first permanent molars were assessed
for enamel defects by one calibrated examiner, using the modified Developmental
Defects of Enamel Index (DDE Index). Only fully erupted molars were assessed
and clinical photos were taken for every molar examined. Differences between
groups were investigated with Chi square statistis, while the Spearman
correlation coefficient was used to test bivariate associations. Logistic
regression was used to calculate odds ratios and 95% confidence intervals. The
level of significance was set at 95%.
Results: Developmental defects of enamel were present in 24 children (34.3 %)
in the study group and only in 6 (8.6%) in the control, the difference between
the two groups being statistically significant (x2=12.26, P<0.001). The
estimated odds ratio for any enamel defect in first permanent molars, among
children in the study group was 5.56 (95% CI:2,1-14,7). Hypoplasia with loss of
enamel was observed in 41.6% of the children with affected molars, while 58.3%
had at least one molar with a defect extending to >2/3 of the tooth crown.
Demarcated opacities were present in 20.8% of the patients with affected
molars. There was no difference between children that used bronchodilators only
compared to those that used a combined bronchodilator/corticosteroid regiment
regarding the presence, severity or extent of enamel defects. Also, the age at
treatment onset and duration of drug use were not significantly associated with
the severity and extent of enamel defects. Gender was significantly correlated
with enamel defects occurrence, in the study group (rho:0.293, p<0.01). In the
multivariate model, gender (girls) showed an odds ratio for enamel defects of
3.61 and was a significant influential factor, while the other factors included
in the model (prolonged nursing, premature birth, frequent antibiotic intake,
mother’s smoking) were not found to significantly influence enamel defect
development.
Conclusions: Children that were treated with bronchodilators and /or
corticosteroids for asthma like episodes during their first 4 years of life
showed an overall increased risk of developmental defects of enamel in first
permanent molars. Severe hypoplastic lesions with loss of enamel, involving
most of the tooth crown was a frequent finding among children with affected
molars.
Keywords:
Developmental defects of enamel, Children, Molars, Asthma, Asthma drugs
