Difficulties in identifying developmental defects of the enamel: a BITA study

Area of Science:

• Dental Public Health
• Pediatric Dentistry
• Restorative Dentistry

Background:

• Developmental Defects of Enamel (DDE) are common, yet accurate diagnosis can be challenging for general dental staff.
• The BITA study aimed to assess DDE prevalence, necessitating reliable diagnostic skills among dental professionals.
• Distinguishing between different DDE types and conditions like Molar Incisor Hypomineralisation (MIH) is crucial for appropriate patient management.

Purpose of the Study:

• To assess the diagnostic capabilities of general dental staff in identifying DDE before and after specific training.
• To evaluate the long-term validity and reliability of DDE registrations and MIH diagnoses made during the BITA study.
• To determine the reliability of MIH diagnoses retrospectively, three years after the initial study.

Main Methods:

• A trained group (n=43) and an untrained group (n=60) of dental staff completed a test protocol using digital photos of DDE.
• Clinical re-examinations of 91 patients with reported DDE were conducted three years later by experienced dentists.
• Inter-rater reliability for DDE classification and MIH diagnosis was assessed.

Main Results:

• Untrained staff correctly assessed only 42% of affected surfaces, whereas trained staff achieved 85% accuracy (p < 0.000).
• Specialists confirmed 73% of teeth previously diagnosed with DDE in the BITA study.
• Agreement on classifying opacities as diffuse or demarcated was 76%; 25% of presumed MIH cases had other enamel disturbances.

Conclusions:

• General dental staff require specific training to adequately recognize DDE.
• Instruction using digital images significantly enhances diagnostic accuracy for DDE.
• Longitudinal follow-up until permanent teeth eruption is recommended for accurate MIH diagnosis.