Factors and Mechanisms Involved in Acquired Developmental Defects of Enamel: A Scoping Review

Abstract

BackgroundDevelopmental Defects of Enamel (DDE) is a pathology of the teeth that can greatly alter the quality of life of patients (hypersensitivity, esthetic issues, loss of function, etc.). The acquired DDE may occur as a result of a wide range of acquired etiological factors and his prevalence of this pathology may reach up to 89.9%. The main objective of this research was to identify and analyze, in current literature, the factors related to acquired DDE, in order to propose a general theory about the mechanisms involved.MethodsThe search of the primary literature was conducted until [December 31, 2021]. Our search strategy uses the Pubmed/MEDLINE database and was structured around 3 terms [“Development,” “Defect,” and “Enamel”]. To be included, references had to be primary studies, written in English. Exclusion criteria were reviews, in vitro, animal, genetic or archeology studies, and studies focused on clinical management of DDE. One hundred and twenty three articles were included in this scoping review: 4 Randomized clinical trials, 1 letter, 5 cases reports, 2 fundamentals studies, and 111 observational studies (33 Cross-sectional studies, 68 Cohort study and 10 Case-control study). The quality of evidence was assessed using the PEDro scale for clinical trials, the Newcastle-Ottawa scale for observational studies, and a published tool to assess the quality of case reports and case series.ResultsA scoping review of the literature identified 114 factors potentially involved in acquired DDE. The most frequently encountered pathologies are those causing a disorder of calcium homeostasis or a perturbation of the ARNT pathway in mother or child. The link between the ARNT pathway and metabolism deficiency in uncertain and needs to be defined. Also, the implication of this mechanism in tissue impairment is still unclear and needs to be explored.ConclusionsBy identifying and grouping the risk factors cited in the literature, this taxonomy and the hypotheses related to the mechanism allow health practitioners to adopt behaviors that limit the risk of developing aDDE and to set up a prevention of dental pathology. In addition, by reviewing the current literature, this work provides guidance for basic research, clinical studies, and literature searches.

Developmental Enamel Defects in Children from the Southern Region of Ecuador

“…These findings are consistent with the results of other studies, especially in low-income populations [ 28 , 29 ]. The increased risk of DDEs in the permanent dentition is probably related to a critical period of amelogenesis between 0 and 2 years of age, when the child is particularly vulnerable to several common systemic conditions that can affect enamel development [ 1 , 6 , 28 ].…”

“…Developmental defects of enamel (DDEs) are alterations in the quality and quantity of enamel caused by disruption or damage of the dental organ during the process of amelogenesis [ 1 , 2 , 3 ]. The permanent dentition begins its mineralization in the 28th week of gestation and is completed at 3 years of life.…”

“…The factors that can interfere with the metabolic process of enamel formation and produce DDEs are generally divided into two groups: acquired and hereditary [ 1 ]. The risk factors for acquired DDEs are divided into prenatal, natal, and postnatal factors.…”

“…Regarding prenatal factors, research has shown a higher frequency of DDEs in children who have suffered intrauterine malnutrition, inadequate nutrition during fetal development, medical complications during pregnancy related to vitamin D deficiency, low calcemic, gestational diabetes, maternal psychological stress, anemia related to hypotension, and frequent exposure to radiographs in the last trimester of pregnancy [ 5 , 8 , 9 , 10 , 11 ]. Regarding natal factors, the literature mentions that the development of DDEs would be influenced by delivery complications, such as premature delivery, low birth weight, vitamin D deficiencies, low calcemic, and low vitamin A levels [ 1 , 12 ]. On the other hand, postnatal risk factors include severe illness in the first 3 years of life, vitamin D deficiency, infectious episodes, thyroid dysfunction, use of drugs such as antiretrovirals, and antibiotics, especially penicillin [ 13 , 14 ].…”

“…Disorders that occur during the early stages of enamel development will result in a reduction in the amount or thickness of enamel, i.e., enamel hypoplasia, which is defined as a deficiency in the amount of enamel resulting from developmental changes. This clinically may present as pits, cracks, or loss of large areas of enamel [ 1 , 17 ]. Conversely, disorders that occur during the calcification and maturation phase of enamel development may result in mineralization deficiencies (hypocalcification) and usually manifest as changes in enamel translucency or opacities that may be diffuse or demarcated [ 5 , 18 ].…”