Table_3_Factors and Mechanisms Involved in Acquired Developmental Defects of Enamel: A Scoping Review.docx

BackgroundDevelopmental Defects of Enamel (DDE) is a pathology of the teeth that can greatly alter the quality of life of patients (hypersensitivity, esthetic issues, loss of function, etc.). The acquired DDE may occur as a result of a wide range of acquired etiological factors and his prevalence of this pathology may reach up to 89.9%. The main objective of this research was to identify and analyze, in current literature, the factors related to acquired DDE, in order to propose a general theory about the mechanisms involved.
MethodsThe search of the primary literature was conducted until [December 31, 2021]. Our search strategy uses the Pubmed/MEDLINE database and was structured around 3 terms [“Development,” “Defect,” and “Enamel”]. To be included, references had to be primary studies, written in English. Exclusion criteria were reviews, in vitro, animal, genetic or archeology studies, and studies focused on clinical management of DDE. One hundred and twenty three articles were included in this scoping review: 4 Randomized clinical trials, 1 letter, 5 cases reports, 2 fundamentals studies, and 111 observational studies (33 Cross-sectional studies, 68 Cohort study and 10 Case-control study). The quality of evidence was assessed using the PEDro scale for clinical trials, the Newcastle-Ottawa scale for observational studies, and a published tool to assess the quality of case reports and case series.
ResultsA scoping review of the literature identified 114 factors potentially involved in acquired DDE. The most frequently encountered pathologies are those causing a disorder of calcium homeostasis or a perturbation of the ARNT pathway in mother or child. The link between the ARNT pathway and metabolism deficiency in uncertain and needs to be defined. Also, the implication of this mechanism in tissue impairment is still unclear and needs to be explored.
ConclusionsBy identifying and grouping the risk factors cited in the literature, this taxonomy and the hypotheses related to the mechanism allow health practitioners to adopt behaviors that limit the risk of developing aDDE and to set up a prevention of dental pathology. In addition, by reviewing the current literature, this work provides guidance for basic research, clinical studies, and literature searches.

背景：牙釉质发育缺陷（Developmental Defects of Enamel, DDE）是一类可显著影响患者生活质量的牙齿病理状态，可引发牙齿敏感、美观问题、功能丧失等诸多不良后果。获得性牙釉质发育缺陷可由多种后天致病因素诱发，该类疾病的患病率最高可达89.9%。本研究的主要研究目标为：通过梳理现有文献，分析与获得性牙釉质发育缺陷相关的致病因素，进而针对其潜在发病机制提出普适性理论。
方法：本次文献检索的截止日期为2021年12月31日，检索数据库选用PubMed/MEDLINE，检索策略以“Development”“Defect”“Enamel”三个关键词为核心构建。纳入标准为：以英文发表的原创性研究。排除标准包括：综述类文献、体外实验研究、动物实验研究、遗传学研究、考古学研究，以及聚焦于牙釉质发育缺陷临床诊疗的研究。本范围综述最终纳入123篇文献，其中包含4项随机临床试验、1篇信函、5篇病例报告、2项基础研究，以及111项观察性研究（含33项横断面研究、68项队列研究与10项病例对照研究）。证据质量评估方面，针对随机临床试验采用PEDro量表（PEDro scale），观察性研究采用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale），病例报告及病例系列研究则采用已发表的专用评估工具。
结果：本次范围综述共识别出114项与获得性牙釉质发育缺陷潜在相关的致病因素。其中最为常见的关联病理状态为可引发母体或子代钙稳态紊乱，或干扰芳烃受体核转运蛋白（ARNT）通路的各类情形。目前ARNT通路与代谢缺陷之间的关联尚不明确，有待进一步阐明；同时，该通路在组织损伤中的作用机制也仍需深入探索。
结论：本研究通过梳理并归类现有文献中提及的风险因素，所提出的分类体系及相关发病机制假说，可协助临床从业者采取针对性防控措施以降低获得性牙釉质发育缺陷的发病风险，并为该类牙齿病理的预防工作提供指导。此外，通过对现有文献的系统梳理，本研究也可为基础研究、临床研究及文献检索工作提供参考方向。