European Archives of Paediatric Dentistry

, Volume 15, Issue 4, pp 275–280 | Cite as

Related factors of dental caries and molar incisor hypomineralisation in a group of children with cystic fibrosis

  • S. Peker
  • S. Mete
  • Y. Gokdemir
  • B. Karadag
  • B. KargulEmail author
Original Scientific Article



To investigate dental caries and molar incisor hypomineralisation (MIH)-related factors such as treatment, diet, brushing and salivary factors in children with cystic fibrosis (CF) compared with healthy peers.

Study design

A cohort study was performed.


This study was performed on 30 CF children comprising patients at the Faculty of Medicine and 30 control children recruited from the Dental School. Salivary factors, dental caries, MIH, daily diet, brushing habits were analysed. Statistical analysis was calculated by SPSS for Windows.


Decay missing filled teeth (DMF-T) score was 4.6 ± 4.0 in CF and 7.7 ± 2.7 in control (p = 0.001). 43 % of CF children with MIH were found to use antibiotics, but no significant difference in the caries experience was found with antibiotic usage (p > 0.05). DMF-T of CF adolescents (23 %) who use Tobramycin was 7 ± 3.5. DMF-T of CF children (20 %) who take other antibiotics was 2.5 ± 3.5, but no statistical difference was found (p = 0.054). Saliva pH, salivary flow rate, and buffering capacity were not found statistically significant (p > 0.05).


Percentage arithmetic mean value, standard deviation, independent sample t test, Fisher’s exact test, Chi-square test and Mann–Whitney U test were used, while a p value of <0.05 was considered statistically significant.


Medication and diet could be considered as a risk factor for dental caries and factors such as salivary pH, good oral hygiene could play a protective role for oral health CF children. MIH frequency and lower caries experience seen in CF children could be due to salivary factors or pharmacological treatment they take. The multidisciplinary approach team would be advantageous in the management of children with CF and oral health should be under control during early years of life by paediatric dentists.


Cystic fibrosis Children Dental caries Saliva Molar incisor hypomineralisation 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. Aps JK, Van Maele GO, Martens LC. Caries experience and oral cleanliness in cystic fibrosis homozygotes and heterozygotes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002a;93(5):560–3.PubMedCrossRefGoogle Scholar
  2. Aps JK, Delanghe J, Martens LC. Salivary electrolyte concentrations are associated with cystic fibrosis transmembrane regulator genotypes. Clin Chem Lab Med. 2002b;40(4):345–50.PubMedCrossRefGoogle Scholar
  3. Aps JK, Van Maele GO, Martens LC. Oral hygiene habits and oral health in cystic fibrosis. Eur J Paediatr Dent. 2002c;3(4):181–7.PubMedGoogle Scholar
  4. Arquitt CK, Boyd C, Wright JT. Cystic fibrosis transmembrane regulator gene (CFTR) is associated with abnormal enamel formation. J Dent Res. 2002;81(7):492–6.PubMedCrossRefGoogle Scholar
  5. Atar M, Körperich EJ. Systemic disorders and their influence on the development of dental hard tissues: a literature review. J Dent. 2010;38:296–306.PubMedCrossRefGoogle Scholar
  6. Azevedo TD, Feijó GC, Bezerra AC. Presence of developmental defects of enamel in cystic fibrosis patients. J Dent Child. 2006;73(3):159–63.Google Scholar
  7. Bals R, Hubert D, Tummler B. Antibiotic treatment of CF lung disease: from bench to bedside. J Cyst Fibros. 2011;10:146–51.CrossRefGoogle Scholar
  8. Catalán MA, Scott-Anne K, Klein MI. Elevated ıncidence of dental caries in a mouse model of cystic fibrosis. PLoS One. 2011;6(1):e16549. doi: 10.1371/journal.pone.0016549.PubMedCentralPubMedCrossRefGoogle Scholar
  9. Chi DL. Dental caries prevalence in children and adolescents with cystic fibrosis: a qualitative systematic review and recommendations for future research. Int J Paediatr Dent. 2013;23(5):376–86. doi: 10.1111/ipd.12042.PubMedCrossRefGoogle Scholar
  10. Costa-Silva CM, Jeremias F, Souza JF, et al. Molar-incisor hypomineralisation: prevalence, severity and clinical consequences among Brazilian children. Int J Paediatr Dent. 2010;20:426–34.PubMedCrossRefGoogle Scholar
  11. Costa-Silva CM, Ambrosano GMB, Jeremias F, Souza JF, Mialhe FL. Increase in severity of molar-incisor hypomineralisation and its relationship with colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011;21:333–41.PubMedCrossRefGoogle Scholar
  12. Dabrowska E, Błahuszewska K, Minarowska A. Assessment of dental status and oral hygiene in the study population of cystic fibrosis patients in the Podlasie province. Adv Med Sci. 2006;51(1):100–3.PubMedGoogle Scholar
  13. Davies H, Bagg J, Muxworthy S, Goodchild MC, McPherson MA. Electrolyte concentrations in control and cystic fibrosis submandibular saliva. Biochem Soc Trans. 1990;18(3):447–8.PubMedGoogle Scholar
  14. Edgar WM, Bowen WH, Cole MF. Development of rampant dental caries, and composition of plaque fluid and saliva in irradiated primates. J Oral Pathol. 1981;10:284–95.PubMedCrossRefGoogle Scholar
  15. Fernald GW, Roberts MW, Boat TF. Cystic fibrosis: a current review. Pediatr Dent. 1990;12(2):72–8.PubMedGoogle Scholar
  16. Ferrazzano GF, Orlando S, Sangianantoni G. Dental and periodontal health status in children affected by cystic fibrosis in a southern Italian region. Eur J Paediatr Dent. 2009;10(2):65–8.PubMedGoogle Scholar
  17. Ferrazzano GF, Sangianantoni G, Cantile T, et al. Dental enamel defects in Italian children with cystic fibrosis: an observational study. Community Dent Health. 2012;29(1):106–9.PubMedGoogle Scholar
  18. Gawenis LR, Spencer P, Hillman LS, et al. Mineral content of calcified tissues in cystic fibrosis mice. Biol Trace Elem Res. 2001;83:69–81.PubMedCrossRefGoogle Scholar
  19. Ghanim A, Marino R, Morgan M, Bailey D, Manton D. An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren. Int J Paediatr Dent. 2013;23:2–12.PubMedCrossRefGoogle Scholar
  20. Jagels A, Sweeney EA. Oral health of patients with cystic fibrosis and their siblings. J Dent Res. 1975;55:991–5.CrossRefGoogle Scholar
  21. Jasulaityte L, Veerkamp JS, Weerheijm KL. Molar-incisor-hypomineralisation: review and prevalence data from a study of primary school children in Kaunas (Lithuania). Eur Arch Paediatr Dent. 2007;8(2):87–94.PubMedCrossRefGoogle Scholar
  22. Kargul B, Tanboga I, Ergeneli S, Karakoc F, Dagli E. Inhaler medicament effects on saliva and plaque pH in asthmatic children. J Clin Pediatr Dent. 1998;22(2):137–40.PubMedGoogle Scholar
  23. Kinirons MJ. Increased salivary buffering in association with a low caries experience in children suffering from cystic fibrosis. J Dent Res. 1983;62:815–7.PubMedCrossRefGoogle Scholar
  24. Kinirons MJ. Dental health of patients suffering from cystic fibrosis in northern Ireland. Community Dent Health. 1989;6:113–20.PubMedGoogle Scholar
  25. Kinirons MJ. The effects of antibiotic therapy on the oral health of cystic fibrosis children. Int J Paediatr Dent. 1992;2:139–43.PubMedCrossRefGoogle Scholar
  26. Kuscu OO, Sandalli N, Dikmen S, et al. Association of amoxicillin use and molar incisor hypomineralisation in piglets: visual and mineral density evaluation. Arch Oral Biol. 2013;58:1422–33.PubMedCrossRefGoogle Scholar
  27. Littleton NW, White CL. Dental findings from a preliminary study of children receiving extended antibiotic therapy. J Am Dent Assoc. 1964;68:520–5.PubMedGoogle Scholar
  28. Lygidakis NA, Dimou G, Marinou D. Molar-incisor-hypomineralisation (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors. Eur Arch Paediatr Dent. 2008;9(4):207–17.PubMedCrossRefGoogle Scholar
  29. Martens LC, Aps JKM, Van Maele GOG. Is oral health at risk in people with cystic fibrosis? Eur J Paediatr Dent. 2001;2:21–7.Google Scholar
  30. Narang A, Maguire A, Nunn JH, Bush A. Oral health and related factors in cystic fibrosis and other chronic respiratory disorders. Arch Dis Child. 2003;88:702–7.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Rosenstein BJ, Cutting GR. For the cystic fibrosis foundation consensus panel. The diagnosis of cystic fibrosis: a consensus statement. J Pediatr. 1998;132:589–95.PubMedCrossRefGoogle Scholar
  32. Schwiebert LM, Estell K, Propst SM. Chemokine expression in CF epithelia: implications for the role of CFTR in RANTES expression. Am J Physiol. 1999;276:700–10.Google Scholar
  33. Sui W, Boyd C, Wright JT. Altered pH regulation during enamel development in the cystic fibrosis mouse incisor. J Dent Res. 2003;82:388–92.PubMedCrossRefGoogle Scholar
  34. van Westreenen M, Tiddens HA. New antimicrobial strategies in cystic fibrosis. Paediatr Drugs. 2010;12:343–52.PubMedCrossRefGoogle Scholar
  35. Weerheijm KL. Molar ıncisor hypomineralisation (MIH). Eur J Paediatr Dent. 2003;4:115–20.Google Scholar
  36. Welsh MJ, Ramsey BW, Accurso FJ, Cutting GR. Cystic fibrosis. In: Scriver CF, Beaudet AL, Sly WS, editors. The metabolic and molecular bases of inherited disease. New York: McGraw-Hill; 2001. p. 5122–88.Google Scholar
  37. Whatling R, Fearne JM. Molar incisor hypomineralisation: a study of aetiological factors in a group of UK children. Int J Paediatr Dent. 2008;18(3):155–62.PubMedCrossRefGoogle Scholar
  38. William V, Messer LB, Burrow MF. Molar incisor hypomineralisation: review and recommendations for clinical management. Pediatr Dent. 2006;28(3):224–32.PubMedGoogle Scholar
  39. Willmott NS, Bryan RAE, Duggal MS. Molar-incisor-hypomineralisation: a literature review. Eur Arch Paediatr Dent. 2008;9(4):172–9.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2014

Authors and Affiliations

  • S. Peker
    • 1
  • S. Mete
    • 1
  • Y. Gokdemir
    • 2
  • B. Karadag
    • 2
  • B. Kargul
    • 1
    Email author
  1. 1.Department of Paediatric Dentistry, Dental SchoolMarmara UniversityIstanbulTurkey
  2. 2.Division of Paediatric Pulmonology, Faculty of MedicineMarmara UniversityIstanbulTurkey

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