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

Journal article
Authors Birgitta Jälevik
A. Szigyarto-Matei
Agneta Robertson
Published in European Archives of Paediatric Dentistry
Volume 20
Issue 5
Pages 481-488
ISSN 1818-6300
Publication year 2019
Published at Institute of Odontology
Institute of Odontology, Section 3
Pages 481-488
Language en
Keywords Enamel, Hypomineralisation, Hypoplasia, Identification, enamel hypoplasia, human, incisor, prevalence, reproducibility, Dental Enamel, Dental Enamel Hypoplasia, Humans, Reproducibility of Results
Subject categories Dentistry


Aim: To evaluate the ability to recognise different types of developmental defects of enamel (DDE) by a group of general dental staff, trained prior to the comprehensive prevalence study (the BITA study), and to compare their skills to that of an untrained group. To evaluate the validity and reliability of the DDE registrations and MIH diagnoses, 3 years after the BITA study ended. To evaluate the reliability of an MIH diagnose, 3 years after the study ended. Materials and methods: The dental staff from five clinics (n = 43) was given instructions in identifying different types of DDE, according to the mDDE index (FDI in Int Dent J 42:411–426 1992). A test protocol with 24 digital photos of teeth with different DDE was filled out. The dental staff from five other clinics (n = 60), without preceding instructions, also filled out the protocol. Ninety-one patients with reported DDE were clinically re-examined 3 years later by two dentists with certified experience of DDE. Results: When untrained dental staff filled out the test protocol, only 42% of the affected surfaces were correctly assessed, whereas 85% of the dental staff instructed in recognizing DDE made a correct assessment (p < 0.000). The specialists confirmed 73% of the teeth diagnosed with DDE in the BITA study as affected. The agreement in judging the opacities as diffuse or demarcated was 76%. One-fourth of those being judged to be affected by MIH in the BITA-study also showed to be affected by other enamel disturbances. Conclusions: The ability of the untrained dental staff to recognize DDE was insufficient. Instructions, using digital photos, raised the ability considerably. To ensure a correct MIH diagnosis, the patients should be followed until all the permanent teeth have erupted. © 2019, The Author(s).

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