Modifiable factors associated with developmental defects of enamel in primary and permanent teeth: a cross-sectional clinical and questionnaire-based study.
4 affiliations
- 1Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
- 2Department of Pediatric Dentistry, Qingdao Stomatological Hospital Affiliated to Qingdao University, No.17 Dexian Road, Shinan District, Qingdao, Shandong Province, 266001, China.
- 3Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China. [email protected].
- 4Department of Pediatric Dentistry, Qingdao Stomatological Hospital Affiliated to Qingdao University, No.17 Dexian Road, Shinan District, Qingdao, Shandong Province, 266001, China. [email protected].
Abstract
Background
Developmental defects of enamel (DDE) represent a significant public health concern in pediatric populations, contributing to elevated caries susceptibility, aesthetic problems, and impaired masticatory function. This study aimed to identify independent, modifiable associated factors for DDE and to construct a predictive nomogram for individualized risk stratification.Methods
A population-based cross-sectional study included 106 children randomly recruited from the Department of Pediatric Dentistry, Qingdao Stomatological Hospital Affiliated to Qingdao University. DDE was diagnosed per standardized clinical criteria in both primary and permanent teeth. Based on existing evidence and published studies, a questionnaire was developed for this study to explore DDE associated factors during the perinatal and early postnatal periods. Univariate logistic regression analysis was employed to screen potential predictors, with significant variables (P < 0.10) entered into a stepwise multivariate logistic regression model. Model performance was evaluated using discrimination (area under curve [AUC]), calibration, and 10-fold cross-validation (CV) repeated 200 times. A clinical nomogram was developed based on the final regression model.Results
The univariate logistic regression analysis revealed 6 variables associated with DDE at P < 0.10. After multivariate logistic regression analysis, only 2 independent predictors of DDE remained: frequent use of plastic feeding bottle or pacifiers in children (Odds Ratio [OR] = 4.069, 95% confidence interval [CI]: 1.679-9.861, P = 0.002) and routine supplement intake during maternal pregnancy (OR = 0.314, 95% CI: 0.122-0.807, P = 0.016). The predictive model demonstrated moderate discriminative validity (AUC = 0.683) and good internal consistency (mean cross-validated AUC = 0.685). A visual nomogram was constructed to quantify the individual risk of DDE based on these two key factors.Conclusions
This clinical epidemiology study confirms that plastic feeding bottle or pacifier exposure is an associated factor for DDE, while prenatal maternal supplementation may serves as a helpful factor. The developed nomogram provides a laboratory tool for individualized DDE risk preliminary stratification, and only functions as an initial prototype for the further construction and optimization of DDE risk prediction models.Trial registration
Not applicable.
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BibTeX
@article{pan2026modifiable,
title = {{Modifiable factors associated with developmental defects of enamel in primary and permanent teeth: a cross-sectional clinical and questionnaire-based study.}},
author = {Yue Pan and Leina Gao and Huali Gao and Xiaoling Luan and Xiaoyan Wang and Dixin Cui},
journal = {BMC oral health},
year = {2026},
month = aug,
doi = {10.1186/s12903-026-09532-8},
url = {https://europepmc.org/article/MED/42972534},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Modifiable factors associated with developmental defects of enamel in primary and permanent teeth: a cross-sectional clinical and questionnaire-based study.
AU - Yue Pan
AU - Leina Gao
AU - Huali Gao
AU - Xiaoling Luan
AU - Xiaoyan Wang
AU - Dixin Cui
PY - 2026
DA - 2026/08/05
JO - BMC oral health
DO - 10.1186/s12903-026-09532-8
UR - https://europepmc.org/article/MED/42972534
AB - Background Developmental defects of enamel (DDE) represent a significant public health concern in pediatric populations, contributing to elevated caries susceptibility, aesthetic problems, and impaired masticatory function. This study aimed to identify independent, modifiable associated factors for DDE and to construct a predictive nomogram for individualized risk stratification.Methods A population-based cross-sectional study included 106 children randomly recruited from the Department of Pediatric Dentistry, Qingdao Stomatological Hospital Affiliated to Qingdao University. DDE was diagnosed per standardized clinical criteria in both primary and permanent teeth. Based on existing evidence and published studies, a questionnaire was developed for this study to explore DDE associated factors during the perinatal and early postnatal periods. Univariate logistic regression analysis was employed to screen potential predictors, with significant variables (P < 0.10) entered into a stepwise multivariate logistic regression model. Model performance was evaluated using discrimination (area under curve [AUC]), calibration, and 10-fold cross-validation (CV) repeated 200 times. A clinical nomogram was developed based on the final regression model.Results The univariate logistic regression analysis revealed 6 variables associated with DDE at P < 0.10. After multivariate logistic regression analysis, only 2 independent predictors of DDE remained: frequent use of plastic feeding bottle or pacifiers in children (Odds Ratio [OR] = 4.069, 95% confidence interval [CI]: 1.679-9.861, P = 0.002) and routine supplement intake during maternal pregnancy (OR = 0.314, 95% CI: 0.122-0.807, P = 0.016). The predictive model demonstrated moderate discriminative validity (AUC = 0.683) and good internal consistency (mean cross-validated AUC = 0.685). A visual nomogram was constructed to quantify the individual risk of DDE based on these two key factors.Conclusions This clinical epidemiology study confirms that plastic feeding bottle or pacifier exposure is an associated factor for DDE, while prenatal maternal supplementation may serves as a helpful factor. The developed nomogram provides a laboratory tool for individualized DDE risk preliminary stratification, and only functions as an initial prototype for the further construction and optimization of DDE risk prediction models.Trial registration Not applicable.
SN - 1472-6831
ER -