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Dear Editor,

We read with much interest the recent publication by Reed et al. [1], “Predictors of Developmental Defects of Enamel in the Primary Maxillary Central Incisors using Bayesian Model Selection” published in the February 2024 issue of Caries Research. We appreciate the authors for their novel approach in assessing the linkages among exposome variables during the specific time duration of the development of Developmental Defects of Enamel (DDE) in primary incisors. Although identifying an etiological factor for DDE is challenging due to its multifactorial background, studies investigating risk factors are crucial in helping solve this puzzle.

However, while reading through the paper, we had a few queries/clarifications. It will be highly appreciated if our following queries are clarified by the authors. The authors utilized the Enamel Defects Index, categorizing enamel hypoplasia (EH), opacities (OP), and post-eruptive breakdown (PEB) developed by Brook et al. [2]. Several diagnostic systems have been proposed to evaluate DDE; however, most of them divide the conditions into two broad categories: hypomineralization (opacities) and enamel hypoplasia [3‒5]. In the studied evaluation, and following the proposed index, defects were categorized, including PEB. However, genuinely, PEB is not a different condition from opacities but rather a consequence of it. All post-eruptive fractures in enamel defects are consequences of structure loss in lesions that initially were opacities [6]. Therefore, we do not understand how possible prenatal etiological (or risk) factors could be different.

On the other hand, we speculate that there might be a difference in the severity of opacities. Although not reported, there is much curiosity about the severity of opacities, which manifest in different shades. Were the assessed opacities only the white/creamy ones? Consequently, were the opacities associated with PEB the brown ones and therefore more fragile, leading to fractures?

This is an important discussion that could provide answers about risk factors that result in more severe consequences for defects. Therefore, we would appreciate if the authors could enlighten us on our observations.

The authors have no conflicts of interest to declare.

This work was supported by the Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES) – Financing Code 001.

We certify that we participate sufficiently in the design of the project and/or analysis of the data obtained and/or in the final writing of the article and that everyone agrees with the version sent for publication. Costa L.: writing – review and editing; Santos P.B.: conceptualization, validation, writing – original draft, writing – review and editing, and supervision.

1.
Reed
SG
,
Fan
S
,
Wagner
CL
,
Lawson
AB
.
Predictors of Developmental Defects of Enamel in the Primary Maxillary Central Incisors using Bayesian Model Selection
.
Caries Res
.
2024
;
58
(
1
):
30
8
.
2.
Elcock
C
,
Lath
DL
,
Luty
JD
,
Gallagher
MG
,
Abdellatif
A
,
Bäckman
B
, et al
.
The new Enamel Defects Index: testing and expansion
.
Eur J Oral Sci
.
2006
;
114
(
Suppl 1
):
35
379
.
3.
Ghanim
A
,
Elfrink
M
,
Weerheijm
K
,
Mariño
R
,
Manton
D
.
A practical method for use in epidemiological studies on enamel hypomineralisation
.
Eur Arch Paediatr Dent
.
2015
;
16
(
3
):
235
46
.
4.
Clarkson
J
,
O’Mullane
D
.
A modified DDE Index for use in epidemiological studies of enamel defects
.
J Dent Res
.
1989
;
68
(
3
):
445
50
.
5.
An epidemiological index of developmental defects of dental enamel (DDE Index). Commission on Oral Health, Research and Epidemiology
.
Int Dent J
.
1982
;
32
:
159
67
.
6.
Weerheijm
KL
.
Molar incisor hypomineralisation (MIH)
.
Eur J Paediatr Dent
.
2003. Sep
;
4
(
3
):
114
20
.