, Volume 107, Issue 1, pp 17–22 | Cite as

The higher prevalence of developmental defects of enamel in the dioxin-affected region than non-dioxin-affected region: result from a cross-sectional study in Vietnam

  • Vo Truong Nhu Ngoc
  • Le Thi Huong
  • Bui Van Nhon
  • Ngo Thi Minh Tan
  • Pham Van Thuc
  • Vo Thi Thu Hien
  • Truong Manh Dung
  • Ngo Van Toan
  • Le Quynh Anh
  • Le Hoang Son
  • Thien Chu-DinhEmail author
  • Dinh-Toi ChuEmail author
Original Article


Developmental defects of enamel (DDE) are induced and regulated by several factors including genetics and the environment. There is evidence showing that dioxin in polluted areas has a strong effect on the health and development of teeth. However, there has been no study on DDE in the dioxin-affected regions in Vietnam. To identify the effect of dioxin on the prevalence of DDE in studied areas in Vietnam, a cross-sectional study was conducted in 2200 adults in the A Luoi district in the Thua Thien Hue province (the dioxin-affected region) and in the Kim Bang district in the Ha Nam province (dioxin-unaffected region) in 2015. All subjects were interviewed using a structured questionnaire and their teeth were examined and scored for enamel defects based on the 1992 FDI criteria. The defected teeth were then photographed. Our results showed that the DDE rate in A Luoi was 20.5% when measured as mouth prevalence and 5.8% when measured as tooth prevalence, while the rates in Kim Bang were 10.4 and 2.32% for mouth and tooth prevalence, respectively. Demarcated opacities were predominated in both districts (45.5% in A Luoi and 52.2% in Kim Bang). The DDE rate of the anterior teeth group was higher than that of the posterior teeth group. Most lesions presented on the buccal surface of the tooth. Overall, the DDE prevalence in the dioxin-affected region was 2.2 times higher than that in non-dioxin-affected region in the studied regions in Vietnam.


Developmental defects of enamel Dioxin Hypoplasia Demarcated opacity Diffuse opacity 



We would like to express our deepest gratitude to those people who did not stop in providing their moral support all throughout our study, especially the participants. To the teachers in the 10 80 Committee who created an opportunity for us to carry out this study. To all of you at the commune health stations (A Ngo, Hong Thuong, Hong Van, Huong Lam, Dong Son, Kim Binh, Nhat Tuu, and Hoang Tay), who helped us to complete this study. We also would like to thank our colleagues, especially Dr. Kushi Kushekhar and Dr. Anna Mari Lone (Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Norway) for critical reading and checking to improve the revised manuscript. Dinh-Toi Chu is a researcher under the SCIENTIA FELLOWS programme co-funded by Faculty of Medicine, University of Oslo and the EU Seventh Framework Programme (FP7) Marie S. Curie scheme – People: Cofunding of Regional, National and International Programmes (COFUND), grant agreement no. 609020.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics statement

All study protocols were approved by Hanoi Medical University Ethical Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


  1. 1.
    Harika R, Dutta B, Arun P, Teja RP. A novel clinical approach for long-term retention and durability of resin restorations bonded to multiple developmental defects of enamel. J Int Soc Prev Commun Dent. 2016;6(6):597–601.CrossRefGoogle Scholar
  2. 2.
    CondÒ R, Perugia C, Maturo P, Docimo R. MIH: epidemiologic clinic study in paediatric patient. Oral Implantol. 2012;5(2–3):58–69.Google Scholar
  3. 3.
    Wong HM. Aetiological factors for developmental defects of enamel. Austin J Anat. 2014;1(1).Google Scholar
  4. 4.
    Alaluusua S, Calderara P, Gerthoux PM, Lukinmaa P-L, Kovero O, Needham L, et al. Developmental dental aberrations after the dioxin accident in seveso. Environ Health Perspect. 2004;112(13):1313–8.CrossRefGoogle Scholar
  5. 5.
    Alaluusua S, Lukinmaa P-L. Developmental dental toxicity of dioxin and related compounds—a review. Int Dent J. 2006;56(6):323–31.CrossRefGoogle Scholar
  6. 6.
    Kiukkonen A, Viluksela M, Sahlberg C, Alaluusua S, Tuomisto JT, Tuomisto J, et al. Response of the incisor tooth to 2,3,7,8-tetrachlorodibenzo-p-dioxin in a dioxin-resistant and a dioxin-sensitive rat strain. Toxicol Sci. 2002;69(2):482–9.CrossRefGoogle Scholar
  7. 7.
    Miettinen HM, Sorvari R, Alaluusua S, Murtomaa M, Tuukkanen J, Viluksela M. The effect of perinatal TCDD exposure on caries susceptibility in rats. Toxicol Sci. 2006;91(2):568–75.CrossRefGoogle Scholar
  8. 8.
    Salmela E, Lukinmaa P-L, Partanen A-M, Sahlberg C, Alaluusua S. Combined effect of fluoride and 2,3,7,8-tetrachlorodibenzo-p-dioxin on mouse dental hard tissue formation in vitro. Arch Toxicol. 2011;85(8):953–63.CrossRefGoogle Scholar
  9. 9.
    Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides; Institute of Medicine. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. National Academies Press; 1994.Google Scholar
  10. 10.
    Thang VC, editor. The impact of toxic chemicals which U.S army used in the war on the environment and humans in Viet Nam. The 33 Steering Committee of Ministry of Natural Resources and Environment; 2011.Google Scholar
  11. 11.
    Cau HD, Hung TM, Dung PT, et al. A Luoi—Thua Thien Hue. A land for studying and addressing the consequences of herbicides, fluorescent used in the Second Indochina War (In Vietnamese). Research proceedings. 2000;5(2):43–4.Google Scholar
  12. 12.
    Nguyen L. “Agent orange” sprayed during the Vietnam War still haunt the country. Hiroshima Peace Media Center; 2013.Google Scholar
  13. 13.
    Hoat LN et al. Scientific research in medicine. Medical Publisher. 2015:112–3.Google Scholar
  14. 14.
    Internationale FD. Commission on oral health, research and epidemiology. A review of the developmental defects of enamel index (DDE Index). Int Dent J. 1992;42(6):411–26.Google Scholar
  15. 15.
    McHugh ML. Interrater reliability: the kappa statistic. Biochemia Medica. 2012;22(3):276–82.CrossRefGoogle Scholar
  16. 16.
    Anthonappa RP, King NM. Enamel defects in the permanent dentition: prevalence and etiology. In: Drummond BK, Kilpatrick N, editors. Planning and care for children and adolescents with dental enamel defects: etiology, research and contemporary management. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015; 15–30.Google Scholar
  17. 17.
    Megregian S, Maier FJ, Standard Methods Subcommittee on F. Modified zirconium-alizarin reagent for determination of fluoride in water. J Am Water Works Assoc. 1952;44(3):239–48.CrossRefGoogle Scholar
  18. 18.
    Szumilas M. Explaining odds ratios. J Can Acad Child Adolesc Psychiatry. 2010;19(3):227–9.CrossRefGoogle Scholar
  19. 19.
    Robles MJ, Ruiz M, Bravo-Perez M, González E, Peñalver MA. Prevalence of enamel defects in primary and permanent teeth in a group of schoolchildren from Granada (Spain). Medicina Oral, Patología Oral y Cirugía Bucal. 2013;18(2):e187–93.CrossRefGoogle Scholar
  20. 20.
    Hiller K, Wilfart G, Schmalz G. developmental enamel defects in children with different fluoride supplementation—a follow-up study. Caries Res. 1998;32(6):405–11.CrossRefGoogle Scholar
  21. 21.
    Cau HD, Hung TM, Dung PC, et al. Consequences of chemicals used during the Vietnam War 1961–1971. Res Proc. 2000;2(1):10–7.Google Scholar
  22. 22.
    Vietnam Ministry of Health. National technical regulation on drinking water quality. 2009;4.Google Scholar

Copyright information

© The Society of The Nippon Dental University 2018

Authors and Affiliations

  1. 1.School of Odonto StomatologyHanoi Medical UniversityHanoiVietnam
  2. 2.Department of Science and TechnologyHanoi Medical UniversityHanoiVietnam
  3. 3.10-80 DivisionHanoi Medical UniversityHanoiVietnam
  4. 4.Vinh Medical UniversityVinhVietnam
  5. 5.Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
  6. 6.VNU University of ScienceVietnam National UniversityHanoiVietnam
  7. 7.Institute for Research and DevelopmentDuy Tan UniversityDanangVietnam
  8. 8.Faculty of BiologyHanoi National University of EducationHanoiVietnam
  9. 9.Centre for Molecular Medicine Norway (NCMM), Nordic EMBL Partnership, University of OsloOslo University HospitalOsloNorway

Personalised recommendations