Global burden of molar incisor hypomineralization

Future Perspectives in Pediatric Dentistry: Where are We Now and where are We Heading?

Oral diseases in children are still a major public health problem that can negatively impact parents and their children's quality of life. Even though oral diseases are largely preventable, initial signs of them can be detected in the 1st year of life, and its severity might increase with time if no preventive measures are taken. Based on this, we aim to discuss "where is pediatric dentistry now?" and "where is pediatric dentistry heading?" Early life oral health conditions are a good predictor of oral health status in adolescence, adulthood, and elderly people. A healthy childhood provides the foundation and opportunities for life; therefore, pediatric dentists have the unique opportunity to identify the presence of unhealthy habits in the 1st year of life and educate the parents and family members to change them for life. If all educational and preventive strategies fail or are not put into practice, the child might present oral health problems, such as dental caries, erosive tooth wear (ETW), hypomineralization, and malocclusion, that could have a great impact on other stages of life. At the moment, in pediatric dentistry, there are many alternatives to prevent and treat these oral health problems. However, if prevention fails, minimally invasive approaches, and new dental materials and technologies have been developed recently and will be important tools available in the near future in order to enhance children's oral health.

How to cite this article

Rodrigues JA, Olegario I, Assunção CM, et al. Future Perspectives in Pediatric Dentistry: Where are We Now and where are We Heading? Int J Clin Pediatr Dent 2022;15(6):793-797.

Knowledge and Perceptions of Molar Incisor Hypomineralisation among General Dental Practitioners, Paediatric Dentists, and Other Dental Specialists in Indonesia

Molar incisor hypomineralisation (MIH) is a qualitative, dental enamel hypomineralisation defect affecting one to four first permanent molars, characterised by the present of asymmetries demarcated opacities, and is prevalent worldwide. An early diagnosis of MIH is crucial, to prevent further complications including the development of dental caries, hypersensitivity, pulp inflammation, and pain. Therefore, a thorough understanding of MIH is of clinical importance. This cross-sectional study aimed to evaluate the knowledge and perception of MIH among general dental practitioners (GD), paediatric dentists (PD), and other dental specialists (DS) in Indonesia using a self-administered questionnaire. Chi-square tests and Kruskal−Wallis tests were employed to analyse the data. A total of 266 dental practitioners—112 GD, 84 PD, and 60 DS—were included in this study and completed the online questionnaire. There were significant differences in the overall knowledge scores between GD, PD, and DS (p < 0.001). Specifically, the different between the tested groups were observed in the knowledge of caries pattern related to MIH and the aetiology of MIH. The majority of PD (83.3%) can differentiate the MIH-related caries pattern from the classic caries pattern. Moreover, the confident level in diagnosing and treating MIH teeth were higher in PD compared to GD and DS (p = 0.000). The majority of dental practitioners in all groups agreed on the necessity to obtain continuing education on MIH including the aetiology, diagnosis, and its treatment to improve their knowledge and confidence in MIH clinical management.

Artificial intelligence system for training diagnosis and differentiation with molar incisor hypomineralization (MIH) and similar pathologies

OBJECTIVES

Molar incisor hypomineralization (MIH) is a difficult-to-diagnose developmental disorder of the teeth, mainly in children and adolescents. Due to the young age of the patients, problems typically occur with the diagnosis of MIH. The aim of the present technical note was to investigate whether a successful application of a neural network for diagnosis of MIH and other different pathologies in dentistry is still feasible.

MATERIALS AND METHODS

For this study, clinical pictures of four different pathologies were collected (n = 462). These pictures were categorized in caries (n = 118), MIH (n = 115), amelogenesis imperfecta (n = 112) and dental fluorosis (n = 117). The pictures were anonymized and a specialized dentist taking into account all clinical data did the diagnosis. Then, well-investigated picture classifier neural networks were selected. All of these were convolutional neural networks (ResNet34, ResNet50, AlexNet, VGG16 and DenseNet121). The neural networks were pre-trained and transfer learning was performed on the given datasets.

RESULTS

For the vgg16 network, the precision is the lowest with 83.98% as for the dense121 it shows the highest values with 92.86%. Comparing the different pathologies between the investigated neural networks, there is no trend detectable.

CONCLUSION

In the long term, an implementation of artificial intelligence for the detection of specific dental pathologies is conceivable and sensible.

CLINICAL RELEVANCE

Finally, this application can be integrated in the area of training and teaching in order to teach dental students as well as general practitioners for MIH and similar dental pathologies.

Correlation between Aerosol Therapy and Other Associated Factors in Early Childhood with Molar Incisor Hypomineralization

Context

The etiology of molar incisor hypomineralization (MIH) has been extensively explored. Recently, the effect of drugs used in aerosol therapy in childhood has been implicated as a possible factor in the development of MIH.

Aim

A case-control study was conducted in children aged 6-13 years to determine the association between aerosol therapy and other factors in the development of MIH.

Materials and methods

A total of 200 children were examined for the presence of MIH according to the European Academy of Paediatric Dentistry (EAPD) criteria (2003). Their mothers or primary caregivers were interviewed regarding the preterm history and perinatal, and postnatal history of the child up to 3 years of life.

Statistical analysis

The collected data were subjected to statistical analysis using descriptive and inferential analyses. The p-value ≤ 0.05 was considered statistically significant.

Results

Statistically significant association was observed between the development of MIH and exposure to aerosol therapy in childhood and the use of antibiotics before 1 year of life.

Conclusion

Exposure to aerosol therapy and antibiotics before 1 year of age are risk factors in MIH. Children who had aerosol therapy and antibiotics are 2.01 times and 1.61 times more prone to MIH.

How to cite this article

Shinde MR, Winnier JJ. Correlation between Aerosol Therapy and Other Associated Factors in Early Childhood with Molar Incisor Hypomineralization. Int J Clin Pediatr Dent 2022;15(5):554-557.

Management of compromised first permanent molars in a cohort of UK paediatric patients referred to hospital-based services

BACKGROUND

There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis.

AIM

To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth.

DESIGN

A service evaluation was undertaken, based on case records of medically fit children (6-11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post-eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter-rater kappa 0.96/0.82).

RESULTS

From 349 records screened over a 4-month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst-affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs.

CONCLUSION

Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia.

Artificial intelligence-based diagnostics of molar-incisor-hypomineralization (MIH) on intraoral photographs

OBJECTIVE

The aim of this study was to develop and validate a deep learning-based convolutional neural network (CNN) for the automated detection and categorization of teeth affected by molar-incisor-hypomineralization (MIH) on intraoral photographs.

MATERIALS AND METHODS

The data set consisted of 3241 intraoral images (767 teeth with no MIH/no intervention, 76 with no MIH/atypical restoration, 742 with no MIH/sealant, 815 with demarcated opacity/no intervention, 158 with demarcated opacity/atypical restoration, 181 with demarcated opacity/sealant, 290 with enamel breakdown/no intervention, 169 with enamel breakdown/atypical restoration, and 43 with enamel breakdown/sealant). These images were divided into a training (N = 2596) and a test sample (N = 649). All images were evaluated by an expert group, and each diagnosis served as a reference standard for cyclic training and evaluation of the CNN (ResNeXt-101-32 × 8d). Statistical analysis included the calculation of contingency tables, areas under the receiver operating characteristic curve (AUCs) and saliency maps.

RESULTS

The developed CNN was able to categorize teeth with MIH correctly with an overall diagnostic accuracy of 95.2%. The overall SE and SP amounted to 78.6% and 97.3%, respectively, which indicate that the CNN performed better in healthy teeth compared to those with MIH. The AUC values ranging from 0.873 (enamel breakdown/sealant) to 0.994 (atypical restoration/no MIH).

CONCLUSION

It was possible to categorize the majority of clinical photographs automatically by using a trained deep learning-based CNN with an acceptably high diagnostic accuracy.

CLINICAL RELEVANCE

Artificial intelligence-based dental diagnostics may support dental diagnostics in the future regardless of the need to improve accuracy.

Analysis of Human and Microbial Salivary Proteomes in Children Offers Insights on the Molecular Pathogenesis of Molar-Incisor Hypomineralization

Molar incisor hypomineralization is a complex developmental enamel defect that affects the permanent dentition of children with significant functional and aesthetic implications. Saliva is an ideal diagnostic tool and ensures patients’ compliance by diminishing the discomfort especially in pediatric population. Lately, salivary proteome analysis has progressively evolved in various biomedical disciplines. As changes in saliva composition are associated with oral diseases, it is reasonable to assume that the saliva proteome of MIH-affected children might be altered compared to healthy children. This study analyzed the human and microbial salivary proteome in children with MIH in order to identify salivary markers indicative of the pathology. The conducted proteomic analysis generated a comprehensive dataset comprising a total of 1515 high confidence identifications and revealed a clear discrimination between the two groups. Statistical comparison identified 142 differentially expressed proteins, while the pathway analysis indicated deregulation of inflammation, immune response mechanisms, and defense response to bacteria in MIH patients. Bacterial proteome analysis showed a lower diversity for the microbial species, which highlights the dysbiotic environment established in the MIH pathology.

Case Report: Applicability of sedation with nitrous oxide in the management of molar incisor hypomineralization in pediatric patients

Patients with molar-incisor hypomineralization (MIH) may manifest tooth hfypersensitivity and difficulties in undergoing dental treatment, including fear, anxiety, and behavior problems in the dental office. Then, the objective of this study was to report a clinical case series using inhalation sedation with nitrous oxide and oxygen as a clinical strategy in the management of MIH pediatric patients during dental treatment. Pediatric patients and their legal guardians were properly informed and data were extracted from clinical charts. Six clinical cases were included, whose patients were between 8 and 12 years old. Of these, 4 were female. The indication of moderate sedation took into account the clinical difficulties related to patients with MIH, such as obtaining anesthesia and cooperation, in addition to odontophobia and dental anxiety. All patients were carefully examined to undergo the sedation technique, including medical history and previous experiences with nitrous oxide inhalation sedation, as well as the vital signs were properly evaluated before, during and after the procedures. The nitrous oxide concentration ranged between 30% and 60%. The procedures were restorative, endodontic or surgical (extractions). In general, the use of sedation contributed to the performance of dental procedures. The use of inhaled sedation helped in behavioral management and during the treatment, increasing the effectiveness of local anesthesia. Patients were cooperative for treatment, while no adverse effects or complications related to sedation were observed. Thus, for the patients in this case series, the use of inhalation sedation with nitrous oxide and oxygen contributed to the clinical management of patients with MIH.

"Knowledge, clinical experience, and perceived need for training regarding molar-incisor hypomineralization among a group of Egyptian dental students: a cross-sectional study"

BACKGROUND

Molar-Incisor Hypomineralization (MIH) is a common oral health condition that can lead to difficulties and complications for both dental professionals and patients. It also has a negative impact on the oral health-related quality of life. The present study aimed to assess the knowledge, clinical experience, and perceived need for training of a group of Egyptian dental students regarding MIH.

METHODS

Paper-based survey administration method was used to collect the responses of dental students regarding their knowledge, clinical experience, and perceived need for training about MIH. The survey consisted of two sections of questions regarding clinical features, etiological factors, prevalence, materials used in treating these teeth, factors affecting the choice of restorative materials, and their preferences regarding clinical training of MIH. Descriptive statistics was used for the data analysis by using SPSS® Statistics Version 26.

RESULTS

About two-thirds of the respondents were familiar with MIH (69.2%). The vast majority of students (87.8%) had difficulty distinguishing MIH as a developmental defect that differs from other tooth conditions (p < 0.001); most commonly enamel hypoplasia. The most common defects seen by the respondents were yellow/brown opacities (59.1%). Nearly half of the students (45.2%) choose composite resin as the material of choice for the treatment of MIH-affected teeth with aesthetics being the most common factor affecting the selection of restorative material. Almost all students expressed their needs for further clinical training on MIH, especially on treatment aspects.

CONCLUSIONS

Most students are familiar with MIH theoretically. However, there is an urgent need to include clinical training on MIH diagnosis in the practical sessions of pediatric dentistry courses.

Management of Teeth Affected by Molar Incisor Hypomineralization Using a Resin Infiltration Technique—A Systematic Review

In recent years, an increase in children diagnosed with molar incisor hypomineralization (MIH) has been observed. Children with MIH show a high failure rate with conservative treatment. The ICON® system (DMG, Hamburg, Germany), which is an infiltration of decalcified lesions with resin, may strengthen the tooth structure, improve its aesthetics, and cure hypersensitivity. The following article is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Scientific articles in the PubMed and Google Scholar databases describing the use of the ICON system in the treatment of MIH published in the years 2012–2022 were analyzed. Two independent study authors selected publications that show that the ICON system can be used during the treatment of children with MIH. So far, in the literature, there are no standardized protocols for the dental treatment of patients with hypomineralization of the incisors using the ICON system. Therefore, clinicians rarely use this method of treatment. The ICON system may be successfully used to infiltrate tooth decalcification in children with MIH. However, the depth of infiltration and the achievement of enamel hardness after such therapy are not precisely defined.

Virtual learning object for developing knowledge about the diagnosis and management of molar incisor hypomineralization

AIM

To develop, apply, and evaluate a virtual learning object (VLO) for teaching undergraduate dental students and paediatric dentists to diagnose and manage molar incisor hypomineralization (MIH).

DESIGN

This controlled educational intervention included 170 undergraduate dental students and 50 paediatric dentists. The student intervention group (VLOG) was trained by the VLO, the control group of students (CG) received a synchronous virtual class, and the group of paediatric dentists (PDG) was trained by the VLO. Pre-test and post-test data were analyzed with a mixed one-way and Tukey's post hoc ANOVA test (α = 0.05). The answers to the questionnaire were analyzed with the one-way ANOVA test and Tukey's post hoc test (α = 0.05).

RESULTS

The values obtained in the pre-test were significantly lower than those obtained in the post-test for all groups. The specialists showed a higher level of knowledge before and after the MIH training compared with the students (p < .001). Similarly, statistical differences were found in the level of knowledge, which increased after MIH training (p < .001). There were no differences between the CG and VLOG.

CONCLUSIONS

The level of knowledge increased in all groups after training regardless of the method used. VLOG works similar to traditional teaching approaches.

Knowledge, perception, and clinical experiences on molar incisor hypomineralization amongst Portuguese dentists

Aim

Molar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists.

Methods

A cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS).

Results

Overall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training.

Conclusions

The average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02284-1.

Use of Dental Defects Associated with Low-Dose di(2-Ethylhexyl)Phthalate as an Early Marker of Exposure to Environmental Toxicants

BACKGROUND

Markers of exposure to environmental toxicants are urgently needed. Tooth enamel, with its unique properties, is able to record certain environmental conditions during its formation. Enamel formation and quality are dependent on hormonal regulation and environmental conditions, including exposure to endocrine disrupting chemicals (EDCs). Among EDCs, phthalates such as di-(2-ethylhexyl) phthalate (DEHP) raise concerns about their contribution to various pathologies, including those of mineralized tissues.

OBJECTIVES

The effects of exposure to low-doses of DEHP on the continually growing incisors were analyzed in mouse males and females.

METHODS

Adult male and female C57BL/6J mice were exposed daily to 0.5, 5, and 50μg/kg per day DEHP for 12 wk and their incisors clinically examined. Incisors of males were further analyzed by scanning electron microscopy (SEM), micro X-ray computed tomography (micro-computed tomography; μCT), and nanoindentation for the enamel, histology and real-time quantitative polymerase chain reaction (RT-qPCR) for the dental epithelium.

RESULTS

Clinical macroscopic observations of incisors showed various dose-dependent dental lesions such as opacities, scratches, and enamel breakdown in 30.5% of males (10 of 34 total incisors across three independent experiments), and 15.6% of females (7 of 46 incisors) at the highest dose, among which 18.1% (6 of 34 total incisors across three independent experiments) and 8.9% (4 of 46 incisors), respectively, had broken incisors. SEM showed an altered enamel surface and ultrastructure in DEHP-exposed male mice. Further characterization of the enamel defects in males by μCT showed a lower mineral density than controls, and nanoindentation showed a lower enamel hardness during all stages of enamel mineralization, with more pronounced alterations in the external part of the enamel. A delay in enamel mineralization was shown by several approaches (μCT, histology, and RT-qPCR).

DISCUSSION

We conclude that DEHP disrupted enamel development in mice by directly acting on dental cells with higher prevalence and severity in males than in females. The time window of DEHP effects on mouse tooth development led to typical alterations of structural, biochemical, and mechanical properties of enamel comparable to other EDCs, such as bisphenol A. The future characterization of dental defects in humans and animals due to environmental toxicants might be helpful in proposing them as early markers of exposure to such molecules. https://doi.org/10.1289/EHP10208.

Prevalence, Caries, Dental Anxiety and Quality of Life in Children with MIH in Brussels, Belgium

Molar incisor hypomineralisation (MIH) is a dental enamel pathology responsible for unfavorable functional and aesthetic implications. The objective of this study is to assess the prevalence, dental anxiety, and quality of life related to oral health in children with MIH. In 14 schools in Brussels, Belgium, 290 children aged 8 to 9.5 answered Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Child-Oral Impact on Daily Performance (C-OIDP) questionnaires to assess dental anxiety and quality of life related to oral health (OHRQoL). Oral examinations allowed us to detect MIH according to standardized criteria. The MIH prevalence was 18.6%. The Decayed, Missing and Filled Teeth index (DMFT index) of MIH patients was significantly higher than non-MIH patients (p < 0.001), mainly due to more restored teeth. There was no significant association between MIH and dental anxiety or OHRQoL. Caries in the deciduous dentition was significantly associated with impaired quality of life. The MIH prevalence in Brussels is comparable to other European countries. MIH had no significant impact on dental anxiety and OHRQoL in this sample. The dynamic nature of MIH lesions requires early diagnosis and management to limit the evolution of the severity of the lesions and their implications. It is possible that older age groups may present more symptoms, however, this would require a longitudinal study.

Are yellow-brownish opacities in hypomineralized teeth more prone to breakage than white-creamy ones? A systematic review

OBJETIVE

To evaluate all the available evidence assessing if in hypomineralized teeth, yellow-brownish opacities are more prone to post-eruptive breakdown (PEB) compared to white-creamy opacities.

MATERIALS AND METHODS

Observational studies that evaluated the occurrence of PEB in hypomineralized teeth were considered for inclusion. Electronic searches were performed up to January 2022 in MedLine, LILACS, BBO, Cochrane Library, Web of Science, Scopus, and EMBASE. Neither publication date nor language restrictions were imposed to the searches. Two researchers independently performed the study selection, data extraction, and quality assessment of the included studies according to the Newcastle-Ottawa Scale (NOS). Datasets from studies were grouped for narrative synthesis based on the severity of the PEB (enamel or dentin), type of tooth (molar or incisor), unit of analysis (subject or tooth or tooth surface), and follow-up period (in months). The certainty of evidence was evaluated using the GRADE approach.

RESULTS

Nine studies were included, five cohort and three cross-sectional. All studies assessed the opacities and PEB by visual examination and diagnosed MIH according to EAPD criteria. In the cohort studies, considering all follow-up periods (ranging from 6 to 36 months), dark opacities fractured more than light opacities, at both enamel and enamel/dentin levels, and molars fractured more than incisors. In two out of three cross-sectional studies, dark opacities also fractured more than light opacities, but the deep of the PEB (enamel or dentin breakdown) or the type of tooth (molar or incisor) was not considered in the analysis.

CONCLUSION

Although it seems plausible to state that darker demarcated opacities in MIH patients broke more often than light ones, based on this systematic review of the literature, the certainty of the available evidence about this association is still very low.

CLINICAL RELEVANCE

More reliable and valid research is still necessary to support any future recommendation that MIH children who present yellow-brownish opacities should be monitored at shorter intervals compared to those who present only white-creamy opacities.

Prevalence of molar incisor hypomineralization among school children in Rome, Italy

Molar incisor hypomineralization (MIH) is a highly prevalent condition associated with increased caries experience, dental pain and treatment need. Aim of this study was to determine the prevalence and severity of MIH in a group of 7–8 years old primary school children living in Rome, Italy; and to assess the association with caries experience and possible perinatal risk factors. A survey has been conducted in the city of Rome, between April 2019 and March 2020 with a total of 49 primary schools and 176 2nd grade primary school classes and a total of 3611 children being involved. Of these, a subset of 346 children of 21 primary schools was selected for the epidemiological investigation. The prevalence of MIH was of 18.2%, with girls showing twice the probability of being subject to a mild-severe condition. Molar location was present in 71.4%, while location on both molar plus incisor was present in 28.6% of cases. The mean DMFT was 0.44 ± 0.78, “D” was 0.17 ± 0.58; the mean dmft was 1.7 ± 2.56, “d” was 1.32 ± 2.21. Female gender, caries experience, insufficient oral hygiene were risk factors. The incidence of MIH is increasing in the pediatric population. Knowledge about diagnosis and treatment options should be disseminated among dental professionals.

Prevalence of hypomineralised second primary molars (HSPM): A systematic review and meta-analysis

AIM

To evaluate the prevalence of HSPM worldwide on a child and a tooth level and investigate the influence of diagnostic criteria on the prevalence of HSPM.

DESIGN

A comprehensive literature search was performed through MEDLINE/PubMed, Scopus, and Web of Science databases. The grey literature was also screened as were the reference lists of included studies. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of HSPM.

RESULTS

The search strategy identified 1,988 articles, 487 were retrieved for full-text evaluation, and 37 studies were included in the meta-analysis (32 for child and 23 for tooth level prevalence), providing data from 26,805 individuals and 81,107 molars. The prevalence of HSPM was 6.8% (95% CI 4.98%-8.86%) on a child level and 4.08% on a tooth level (95% CI = 2.80%-5.59%). The diagnostic criteria used did not seem to influence the prevalence results (P > .05). The majority of the papers (75%) showed a low-to-moderate risk of bias.

CONCLUSION

There was a broad variation in the prevalence reported that may be attributed to differences in the study population. The present meta-analysis showed a HSPM prevalence worldwide of 6.8% on a child level and 4.1% on a tooth level.

Molar Incisor Hypomineralization: Awareness among Postdoctoral Dental Residents: A Cross-Sectional Study

Background: Molar incisor hypomineralization (MIH) is the presentation of an enamel defect, where incisors and one (or more) molars are affected. Identifying MIH is significant in restoring its visual defect and avoiding pain or other consequences of this condition. The present cross-sectional study aimed to evaluate the awareness, ability, and confidence in identifying MIH among postgraduate residents in the state of Nevada. Methods: This cross-sectional study was conducted among postdoctoral dental residents at the School of Dental Medicine, University of Nevada, Las Vegas. This cross-sectional study used images of cases of MIH and a survey to collect the data. The survey included demographics, educational background, and basic knowledge of MIH. Results: The response rate to the invitation to participate was 91%. The confidence in identifying MIH was 100%, 50%, and 33.3% for pediatric, orthodontic, and general practice residency (GPR). A total of 70% were aware of this anomaly from their predoctoral dental education and indicated the need for further related education. There was 33% confusion with fluorosis and 16.6% with amelogenesis imperfecta. A total of 66.6% of the participants indicated that they require further education relating to MIH. Conclusion: Within the limitations of the present investigation, MIH awareness among the investigated groups varied but was highest amongst the pediatric residents.

Treatment of Severe Caries and Molar Incisor Hypomineralization and Its Influence on Oral Health-Related Quality of Life in Children: A Comparative Study

BACKGROUND

Treatment of oral diseases can have a long-lasting impact on a child's life well beyond its childhood years. The purpose of this study was to compare the impact of treatment on the oral-health-related quality of life (OHRQoL) of children with severe caries and severe molar incisor hypomineralization (MIH).

METHODS

A total of 210 children (mean age 9 years; 49% female) with severe caries (inner third of dentin) and severe MIH (post-eruptive breakdown, crown destruction) were included in the study. Both groups were matched according to age, gender, and social status. The German version of the Child Perception Questionnaire for 8-10-year-olds (CPQ-G8-10) was used before and after treatment to analyze the impact on OHRQoL.

RESULTS

Patients with severe MIH showed a significantly higher total CPQ score (17.8 (±10.6)) before treatment compared to the caries group (13.8 (±14.3)). The mean CPQ score in all subdomains decreased significantly after therapy in the MIH group. Children with severe carious lesions had similar results except in the domain "functional limitations", as treatment led to only minor changes (2.9 (±3.6) to 2.2 (±2.6)).

CONCLUSIONS

Despite a narrower treatment spectrum, patients with severe MIH experienced a greater overall improvement in OHRQoL compared to the caries group.

Survival of stainless-steel crowns and composite resin restorations in molars affected by molar-incisor hypomineralization (MIH)

BACKGROUND

Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH).

AIM

To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months.

DESIGN

In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval.

RESULTS

The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2).

CONCLUSION

In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months.

The association between molar incisor hypomineralization and oral health-related quality of life: a cross-sectional study

Objectives

We aimed to assess the association between molar incisor hypomineralization (MIH) and the oral health-related quality of life (OHRQoL) in a group of 7- to 14-year-old children in Berlin, Germany.

Materials and methods

The cross-sectional study consisted of a consecutive sample of 317 children, aged 7–14 years (49% girls, 51% boys; mean age, 8.71). Data were collected between June 2018 and December 2019. MIH was diagnosed using the criteria of the European Academy of Paediatric Dentistry. OHRQoL was assessed using the German 19-item version of the Child Oral Health Impact Profile (COHIP-G19). Differences in COHIP-19 summary scores between controls without MIH and MIH patients and with regards to MIH severity were tested for statistical significance using t test and analysis of variance (ANOVA), respectively.

Results

Data were obtained for 217 untreated MIH patients and 100 controls. OHRQoL of MIH patients was significantly more impaired than of controls indicated by COHIP-19 mean scores (60.9 ± 10.7 vs. 67.9 ± 7.8; p < 0.001). Patients with severe MIH (59.6 ± 11.0) reported significantly worse OHRQoL than patients with mild MIH (63.6 ± 9.1; p = 0.013).

Conclusions

MIH has a significant negative impact on the children’s OHRQoL. Patients with severe MIH experience a greater negative impact on OHRQoL than those diagnosed with mild MIH.

Clinical significance

MIH is one of the major dental problems of our time; pediatric dentists should be aware of its impact on the OHRQoL of the patient.

An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis

PURPOSE

To systematically review the aetiological factors associated with molar incisor hypomineralisation (MIH). To this day, the aetiology remains unknown. Determining risk factors would allow risk assessment and enhance early diagnosis of MIH in young patients. The aim was to assess, evaluate and summarise the relationship between MIH and reported aetiological hypotheses.

METHODS

Electronic database searches of MEDLINE, EMBASE, EBSCO, LILACS and Cochrane Library were conducted. Authors conformed to PRISMA guidelines. Studies were screened, data extracted, assessment of risk of bias and calibration was completed by two independent reviewers. Meta-analyses with heterogeneity calculations were performed.

RESULTS

Of the potential 8949 studies, 64 studies were included in the qualitative analysis whilst 45 were included in the quantitative analysis. Prenatal factors: results are inconclusive as only unspecified maternal illnesses appear to be linked to MIH. Perinatal factors: prematurity (OR 1.45; 95% CI 1.24-1.70; p = 0.0002) and caesarean delivery (OR 1.45; 95% CI 1.09, 1.93; p < 0.00001) are associated with an increased risk of developing MIH. Birth complications are also highlighted. These three factors can lead to hypoxia, and children with perinatal hypoxia are more likely to develop MIH (OR 2.76; 95% CI 2.09-3.64; p < 0.0001). Postnatal factors: measles, urinary tract infection, otitis media, gastric disorders, bronchitis, kidney diseases, pneumonia and asthma are associated with MIH. Fever and antibiotic use, which may be considered as consequences of childhood illnesses, are also associated with MIH. Genetic factors: an increasing number of studies highlight the genetic and epigenetic influences in the development of MIH.

CONCLUSION

Several systemic and genetic and/or epigenetic factors acting synergistically or additively are associated with MIH, revealing a multifactorial aetiology model. Peri- and postnatal aetiological factors are more likely to increase the odds of causing MIH than prenatal factors.

Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study

PURPOSE

This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM).

METHODS

Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo^® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively.

RESULTS

SEM observation showed that deproteinisation with Papacarie Duo^® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness.

CONCLUSION

Deproteinisation with Papacarie Duo^® gel followed by acid etching contributed to improved etching patterns on HE.

Worldwide trends on molar incisor and deciduous molar hypomineralisation research: a bibliometric analysis over a 19-year period

AIM

To identify the worldwide trends in scientific evidence and gaps in knowledge regarding molar incisor hypomineralisation (MIH) and deciduous molar hypomineralisation/hypomineralised second primary molars (DMH/HSPM), exploring the contribution of authors and countries, possible etiological factors and proposed treatments, in order to guide future research in the area.

METHODS

Searches were conducted in MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, Embase and Google Scholar. Studies employing the terms MIH, DMH/HSPM and their linguistic variations were included. The following data were extracted: title, authors, year and journal of publication and first author's affiliation country. Studies were categorized according to topic, dentition, study design, etiological factors and types of treatments. Categories were analysed in relation to their distribution, co-occurrence, cross-correlation and/or autocorrelation.

RESULTS

Five hundred and three studies were included. The most published authors were Manton D (n = 47), de Souza JF (n = 22) and Ghanim A (n = 22) and four main collaboration clusters have been identified. Most of the studies were conducted on permanent dentition (MIH) (87.4%); with observational design (57.2%). The "European Archives of Paediatric Dentistry" was the most published journal (13.3%) and a significant increase in the number of publications was observed in the last decade. MIH was most studied in relation to prevalence/incidence, systemic factors involved in its aetiology and treatment with composite restorations, while a gap in knowledge was observed for extraction and sealants. Less studies were published on DMH/HSPM and most of them evaluated risk factors or prevalence/incidence. The gap of knowledge was observed in relation to treatments and patient's quality of life.

CONCLUSIONS

This bibliometric review provided a comprehensive overview of research in MIH and DMH/HSPM over the past 19 years. Within the limitations of the present study, the following conclusions can be drawn: global trends point to an increasing peak of scientific publication, especially in the last decade, while there is a shortage of clinical studies on treatments, mainly evaluating tooth extractions. Finally the multifactorial nature should be further explored, considering environmental and systemic factors together.

The quality and readability of online molar incisor hypomineralisation patient education materials: a systematic analysis

Background

Molar incisor hypomineralization (MIH) is estimated to affect 14% of children worldwide. It is crucial that patients and their families have access to easily comprehensible and reliable MIH‐relevant information. This study aims to determine the quality, reliability and readability of online patient education materials about MIH.

Methods

A systematic search strategy was adopted. Five validated tools were used to assess the content of the 21 websites that satisfied inclusion/exclusion criteria. Data analyses were applied via GraphPad Prism software version 9 (GraphPad Software, San Diego, CA, USA).

Results

Five (23.8%) websites only satisfied the criteria for understandability and two (9.5%) websites satisfied the criteria for actionability using the Patient Education Materials Assessment Tool (PEMAT). No website contained the Health on the Net (HON)Code Seal and the mean (SD) Journal of theAmerican Medical Association number of benchmarks per website was 1.33/4 (1.02). All websites failed to reach recommended minimum readability levels. Higher PEMAT scores were associated with ‘easier’ readability.

Conclusions

Online patient education materials related to MIH are lacking in quality and reliability, and are too difficult for most to read easily. The authors of MIH‐related online content should consider reference to quality of information tools when developing patient education materials.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit

AIM

The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment.

METHODS

Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26.

RESULTS

The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1-6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled.

CONCLUSION

Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Perinatal hypoxia and the risk of severe Molar-Incisor Hypomineralisation (MIH): a retrospective analysis of the pH value of umbilical arterial blood after birth

PURPOSE

Molar-Incisor Hypomineralisation (MIH) remains a widespread developmental disorder of the teeth with a still largely unknown etiology. Perinatal events were blamed in previous studies for the development of MIH. The aim of the present study was to evaluate the influence of perinatal hypoxia-determined by the pH value of the umbilical cord blood-and to investigate its correlation with severe MIH retrospectively. In addition, cesarean section was recorded as differentiation variable.

METHODS

A total number of 138 children (mean age 8.0 years ± 1.7), who were treated for severe MIH in a dental office in Berlin between the years 2008 and 2019, were included in the study. The control group was comprised of patients with the same date of birth (44 children, mean age 7.7 years ± 1.7). Information on the pH value of the arterial blood from the umbilical cord taken immediately after birth, whose recording is mandatory in Germany, was received from the parents by letter survey requesting the entries from the German Child Health Booklet.

RESULTS

In the group of the male children born without cesarean section, the pH value of the control group was significantly lower (7.19 ± 0.09) than the pH value of the MIH group (7.27 ± 0.07, p = 0.0008). In female children born with or without cesarean section as well as in male children born by cesarean section there were no significant differences between the MIH and control group.

CONCLUSIONS

No significant association between MIH and the pH value of the umbilical cord blood or birth by cesarean section could be found in the examined patient population.

Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document

AIM

To update the existing European Academy of Paediatric Dentistry (EAPD) 2010 policy document on the 'Best Clinical Practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH).'

METHODS

Experts, assigned the EAPD, worked on two different topics: (A) Aetiological factors involved in MIH, and (B) Treatment options for the clinical management of MIH. The group prepared two detailed systematic reviews of the existing literature relevant to the topics and following a consensus process produced the updated EAPD policy document on the 'Best Clinical Practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH).' The GRADE system was used to assess the quality of evidence regarding aetiology and treatment which was judged as HIGH, MODERATE, LOW or VERY LOW, while the GRADE criteria were used to indicate the strength of recommendation regarding treatment options as STRONG or WEAK/CONDITIONAL.

RESULTS

(A) Regarding aetiology, it is confirmed that MIH has a multifactorial aetiology with the duration, strength and timing of occurrence of the aetiological factors being responsible for the variable clinical characteristics of the defect. Perinatal hypoxia, prematurity and other hypoxia related perinatal problems, including caesarean section, appear to increase the risk of having MIH, while certain infant and childhood illnesses are also linked with MIH. In addition, genetic predisposition and the role of epigenetic influences are becoming clearer following twin studies and genome and single-nucleotide polymorphisms analyses in patients and families. Missing genetic information might be the final key to truly understand MIH aetiology. (B) Regarding treatment options, composite restorations, preformed metal crowns and laboratory indirect restorations provide high success rates for the posterior teeth in appropriate cases, while scheduled extractions provide an established alternative option in severe cases. There is great need for further clinical and laboratory studies evaluating new materials and non-invasive/micro-invasive techniques for anterior teeth, especially when aesthetic and oral health related quality of life (OHRQoL) issues are concerned.

CONCLUSIONS

MIH has been studied more extensively in the last decade. Its aetiology follows the multifactorial model, involving systemic medical and genetic factors. Further focused laboratory research and prospective clinical studies are needed to elucidate any additional factors and refine the model. Successful preventive and treatment options have been studied and established. The appropriate choice depends on the severity of the defects and the age of the patient. EAPD encourages the use of all available treatment options, whilst in severe cases, scheduled extractions should be considered.

Does molar-incisor hypomineralization (MIH) affect only permanent first molars and incisors? New observations on permanent second molars

BACKGROUND

The second permanent molar plays an important role when considering extraction of first permanent molars severely affected by molar-incisor hypomineralization (MIH).

AIM

To assess the association between MIH and enamel hypomineralization of the second permanent molars in terms of presence and severity.

DESIGN

In this retrospective cross-sectional study, permanent teeth were evaluated in 453 patients between the ages of 13 and 16 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index and dental caries experience using the DMFT and DMFS indices. Statistical analyses were performed using a linear generalized model and ordinal logistic regression.

RESULTS

The most commonly affected teeth by enamel hypomineralization were permanent molars, whereas incisors, premolars, and canines were less affected. The presence of severe defects in the first permanent molars was associated with mild defects in the second permanent molars (OR = 4.01; 95% CI: 2.50-7.77). Enamel hypomineralization was associated with increased caries experience (PR = 5.54; 95% CI: 3.81-9.06).

CONCLUSION

Enamel hypomineralization mainly affects the first and second permanent molars. Mild defects in the second permanent molars tend to be more frequent in patients with severe MIH in the first permanent molars. The presence of enamel hypomineralization was associated with higher dental caries experience.

Relation between molar-incisor hypomineralization (MIH) occurrence and war pollutants in bombarded regions: Epidemiological pilot study in Lebanon

Background

Molar-incisor hypomineralization (MIH), a developmental enamel defect affecting one or more first permanent molars (FPMs) and sometimes incisors (PIs), is one of the most common pandemic health problems in the world. MIH etiology is still unclear and has been suggested to be related to exposure to environmental toxicants during enamel mineralization.

Aims

To assess the susceptibility to MIH occurrence in regards to war pollutants through the investigation of the prevalence and the clinical characteristics of MIH in a group of Lebanese children whose FPMs and PIs enamel mineralization coincides with the 2006 Lebanese war.

Patients and Methods

This cross-sectional study was performed in schools from different regions of Lebanon. Schoolchildren born in 2004, 2005, 2006, and 2007 were examined for MIH. Clinical status, lesion type, extension, and severity were recorded using the short form chart of the MIH index. Pearson's Chi-square or Fischer's exact test were used to determine if there is a significant relationship between categorical variables.

Results

An overall MIH prevalence of 22.93% has been reported. Forty-seven point seventy-five per cent had both molars and incisors affected. Demarcated opacities were the most frequently observed clinical status. Most of the MIH FPMs and PIs were mildly affected with lesions extended on less than the third of the tooth surface.

Conclusions

MIH prevalence among children born around 2006 Lebanese war is high. The hypothesis of a relation between MIH susceptibility and war pollutants in bombarded regions is legible but requires to be elucidated via additional in vitro and in vivo studies for accurate risk assessment.

DNA methylation in childhood dental caries and hypomineralization

OBJECTIVES

Epigenetic modulation of gene expression may be important in dental conditions, including dental caries and enamel hypomineralisation. The aims of this study were to assess associations between DNA methylation in cord blood leucocytes at birth, and caries experience and enamel hypomineralisation at six years of age.

METHOD

The study sample was from a birth cohort study of twins. Dental examinations at six years identified the presence/absence of (i) 'any caries' (untreated and treated caries), (ii) 'advanced caries' (untreated, advanced caries and/or past treatment) and (iii) hypomineralised second primary molars (HSPM). Genome-wide analysis of DNA methylation was performed on cord blood of 27 twin pairs (14 dizygotic and 13 monozygotic) using the Illumina Infinium MethylationEPIC BeadChip array. Differentially methylated CpGs (DMCpGs) and regions (DMRs) associated with each dental outcome were investigated, while accounting for the relatedness of twins. Results with a false discovery rate <0.05 were treated as statistically significant.

RESULTS

19 children had 'any caries', 15 had 'advanced' caries, and 18 had HSPM. No DMCpGs were associated with 'any caries', 16 and 19 DMCpGs were associated with 'advanced caries' and HSPM, respectively. DMRs were identified in association with all three outcomes. Genes implicated by these analyses included PBX1, ACAT2, LTBP3 and DDR1 which have been linked with dental tissue development in genetic studies.

CONCLUSION

This exploratory study identified differential methylation in several genes at birth associated with dental caries and HSPM at six years. Further research may provide valuable insights into aetiology of dental disease and/or reveal novel molecular-based approaches for early risk stratification.

CLINICAL SIGNIFICANCE

Epigenetic differences at birth are likely to be associated with dental health at six years and may be valuable biomarkers of early influences on dental health.

Effects of different remineralization agents on MIH defects: a randomized clinical study

OBJECTIVES

The aim of this study was to present a comparative evaluation of the long-term efficacy of fluoride varnish and pastes containing CPP-ACP and CPP-ACP with fluoride (CPP-ACFP) in the remineralization of creamy-white and yellow-brown defects in permanent first molars with MIH.

MATERIALS AND METHODS

The study included 120 teeth with yellow-brown or creamy-white defects in 67 children (37 girls, 30 boys) aged 6-9 years (mean, 7.2) who were newly diagnosed with MIH with no substance loss or caries or prior restorative treatment. The patients were randomly divided into the experiment groups; control (oral hygiene motivation only), fluoride varnish, and pastes containing CPP-ACP and CPP-ACPF, and followed up for 24 months. The evaluations were made based on the ICDAS criteria and the measurements which were performed using the laser fluorescence method (DIAGNOdent, KaVo, Biberach, Germany) in the follow-ups.

RESULTS

The research was completed with 49 patients (23 females, 26 males; mean age, 7.7) and 90 teeth. All remineralization agents increased remineralization rates in both creamy-white and yellow-brown colored defects without presenting any statistically significant difference at the end of the follow-up period (p > 0.05). However, the effects of fluoride varnishes were late to observe when compared to pastes containing CPP-ACP and CPP-ACPF.

CONCLUSIONS

Pastes containing calcium and phosphate may be recommended for the longer-term preservation of teeth with yellow-brown defects which showed a post-eruptive breakdown in a shorter time.

CLINICAL RELEVANCE

There is a lack of studies investigating MIH treatments in which lesion appearance was recorded. This study evaluated creamy-white and yellow-brown MIH defects separately and reported long-term results of different remineralization agents.

The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis

Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger's significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0-15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0-43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9-6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8-18.3, p < 0.001, I2 = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5-13.5, p < 0.001, I2 = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.

Association Study on Nutrition in the First Year of Life and Molar-Incisor Hypomineralization (MIH)-Results from the GINIplus and LISA Birth Cohort Studies

Molar-incisor hypomineralization (MIH) is a condition with specific clinical presentation whose etiology to date still remains unknown. This study prospectively investigated the association between nutrition during the 1st year of life and the presence of MIH in the permanent dentition. Data from 1070 10-year-old children from two prospective birth cohort studies were included. Information on exclusive breastfeeding (EBF) and introduction of 48 food items into the child’s diet was assessed at 4-, 6-, and 12-month time-points. Food diversity was defined according to the number of food items or food groups introduced into the child’s diet and then subsequent categorization into low-, middle- and high-diversity groups was performed. MIH was scored in the permanent dentition at age of 10 years. The statistical analysis included logistic and Poisson hurdle regression models adjusted for potential confounders. EBF, food item and food group diversity at 4-, 6-, 12-month time-points were found to be non-significant in most of the categories for the development of MIH. However, significantly higher odds for the presence of MIH were found for certain categories. Despite the limitation of this study, such as arbitrary cut-offs for categorization of food items, the results of this study suggest the lack of an association between early nutrition in the first year of life and MIH in the permanent dentition.

Knowledge, attitudes, and beliefs regarding molar incisor hypomineralisation amongst Swiss dental students

Background

Knowledge obtained at the undergraduate level regarding molar incisor hypomineralisation (MIH) has an impact on future practice of dentists and paediatric dentists. This cross-sectional study aimed to assess final-year dental students’ knowledge, attitudes and beliefs towards MIH in all Swiss universities.

Methods

A previously utilised survey (in both English and German) was distributed among final-year dental students in all Swiss dental schools (Basel, Bern, Geneva and Zurich). It probed students’ knowledge, attitudes and beliefs regarding the diagnosis, prevalence, aetiology, and management of MIH, and was structured in two parts: knowledge/perception and clinical application. The students’ responses were analysed statistically with descriptive statistics.

Results

113 out of 133 final-year Swiss dental students took part in the study (85%). Nearly all students were familiar with MIH (99%), but only 12% of them felt confident when diagnosing MIH clinically. Direct composite fillings (66%), indirect restorations (28%) and preformed stainless-steel crowns (26%) were chosen as most suitable treatment options for MIH-affected teeth.

Conclusion

Final-year Swiss dental students are well informed about MIH. However, they report low level of confidence when clinically confronted with MIH-affected teeth regarding its diagnosis and treatment. Swiss Universities curricula should be revisited accordingly.

Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists

OBJECTIVES

To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus.

DESIGN

A prospective cross-sectional study.

SETTING

Part 1: Eastman Dental Institute and part 2: online questionnaire.

METHODS

Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios.

RESULTS

The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21).

CONCLUSION

The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

Hypersensitivity relief of MIH-affected molars using two sealing techniques: a 12-week follow-up

Objectives

The aim of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 12 weeks after sealing using two different materials (composite and glass ionomer). Furthermore, the retention rates of both materials were analyzed.

Methods

Thirty-nine children with two MIH-affected molars showing hypersensitivity and non-occlusal breakdowns were included. Hypersensitivity was assessed with an evaporative (air) stimulus. Both teeth were sealed by two calibrated operators using a split-mouth design with either Clinpro Sealant in combination with Scotchbond Universal (C) or Ketac Universal (K), respectively. Clinical pain assessments (Schiff Score Air Sensitivity Scale [SCASS], Visual Analog Scale [VAS]) were made at baseline (“pre”), immediately after treatment (“post”), and after 1, 4, 8, and 12 weeks. Paired t tests were calculated in each group between baseline and all other time points.

Results

Thirty-eight children with 76 molars completed all stages of the study. Regardless of the material used, the application of the sealant decreased hypersensitivity significantly immediately as well as throughout the 12-week recalls (all p values < 0.001). We found no statistically significant difference among both materials chosen in any of the time points evaluated. Furthermore, retention of both materials was comparable in both groups.

Conclusions

Both sealant materials were able to reduce hypersensitivity successfully immediately and throughout the 12-week follow-up. Furthermore, their performance was similar in terms of retention.

Clinical relevance

Hypersensitivity can be a major complaint in patients with MIH. This is the first study evaluating hypersensitivity relief of MIH-affected molars using two sealing techniques.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10-year-old children

Objectives

The aim of this study was to compare oral health–related quality of life (OHRQoL) in children with and without molar incisor hypomineralization (MIH) and to assess the impact of severity of MIH on OHRQoL in children between 8–10 years using the German version of the Child Perceptions Questionnaire (CPQ-G8-10).

Materials and methods

Children aged 8–10 years were recruited at a pediatric dental clinic in Hannover, Germany. Half of them were affected by MIH. Participants were evaluated for presence and severity of MIH (MIH-TNI), plaque and dental caries status. Children were asked to answer the CPQ-G8-10. Statistical analysis was performed using GraphPad Prism-software version 8.

Results

One hundred eighty-eight children (mean age 8.80 [± 0.84]; 43.10% female) were included in the study with 94 children having MIH. CPQ-G8-10 mean scores in MIH-affected children were significantly higher than in children showing no MIH (13.87 [± 8.91] vs. 4.20 [± 3.74]; p < 0.0001) showing that MIH has negative impact OHRQoL. Similar trends were seen in all four subdomains. Regarding severity, CPQ-G8-10 mean scores increased from mild to severe forms of MIH.

Conclusion

Children affected by MIH show an impaired OHRQoL compared to children without MIH; with increasing severity, OHRQoL gets more impaired.

Clinical relevance

To understand the patient’s perception and the individual oral health needs will help to prioritize MIH and recognize its impact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04150-w.

Knowledge, experience and perception regarding molar incisor hypomineralisation (MIH) among dentists and dental hygienists in Oslo, Norway

Aim

The aim of this study is to gather baseline information on knowledge, perceptions, clinical experience and treatment options regarding MIH among dental care providers in Oslo, Norway, before a larger epidemiological study.

Methods

An electronic questionnaire was distributed to dentists (n = 88) and dental hygienists (n = 47) working in the Public Dental Service (PDS) in Oslo. The questionnaire consisted of five sections related to sociodemographic, clinical experience, perceptions, clinical management and preferences for further training. Descriptive statistics with chi-squared test was used, and level of statistical significance was set to 5%.

Results

Replies were obtained from 74.1% (n = 100) after two reminders. All respondents encountered MIH in their practice. The respondents’ perception of the prevalence of MIH in Oslo varied. The majority felt confident when diagnosing MIH (86%). The clinicians qualified in the last 10 years felt more confident than those who had qualified earlier (p = 0.016). Most were self-confident when treating these patients (68.3%), however, nearly all (88%) agreed that MIH was a clinical problem. The clinician’s treatment of MIH varied. Difficulties achieving adequate local anaesthetic (71.4%) and the child’s behavioural problems (84.1%) were treatment barriers for the dentists. Approximately two thirds (69%) would like further training, in particular on the aetiology (70%), diagnosis (57%) and treatment (77%) of the developmental disorder.

Conclusion

All clinicians were familiar with the diagnosis of MIH and experienced the condition to be a clinical problem. Continuing education on aetiology, diagnosis and treatment of MIH is requested by dental health personnel.

[Molar incisor hypomineralisation (MIH)-discussion of prevalence and etiology with special reference to the results from the Munich birth cohorts GINIplus and LISA]

After caries, molar incisor hypomineralisation (MIH)-also known as chalky teeth-is one the most common dental diseases in children and adolescents. In addition to aesthetic limitations, especially on the anterior teeth, hypersensitivities and enamel breakdowns on permanent molars are of functional importance. While the MIH prevalence rates range from ~ 10% to ~ 30% and is well described, the situation regarding aetiology is unsatisfactory. Although efforts have been made in the past to clarify the aetiology, no plausible reason is available so far. Aetiology research has to be judged as methodologically challenging, since it should ideally be embedded in prospectively planned birth cohort studies. The aim of this article is to summarize typical clinical characteristics of MIH, epidemiological findings and potential causes with special reference to the earlier published results from the two Munich birth cohort studies GINIplus and LISA.

Molar Incisor Hypomineralisation: Current Knowledge and Practice

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.

OBJECTIVES

Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.

MATERIALS AND METHODS

A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.

RESULTS

There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.

CONCLUSIONS

Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

Molar-incisor hypomineralization: an umbrella review

OBJECTIVE

In recent years, Molar Incisor Hypomineralization (MIH) has become a subject that concerns the Paediatric Dentistry Community. The aim of the present umbrella review was to analyse previously published systematic reviews (SRs) on MIH in children and adolescents.

METHODS

Electronic database search was conducted (including PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until July 2020. Studies were included, if they were SR on MIH in children and adolescents. The methodological quality of SRs was judged by use of the MeaSurement Tool to Assess systematic Reviews 2. The primary outcomes included prevalence, aetiology, and clinical management of MIH. Data extraction and methodological quality assessment were performed.

RESULTS

Eighteen systematic reviews were included for data extraction. Among these, two were focussing on prevalence, five addressed aetiology, one highlighted the mechanical and chemical characteristics of enamel in MIH, one underlined the association between MIH and dental caries, six addressed the treatment, and one focussed on hypomineralization of primary teeth as a predictor of MIH. The results showed a high worldwide prevalence of MIH and an unknown aetiology of MIH, but reporting that the aetiology is most likely multifactorial. Different treatment approaches used were desensitizing and remineralizing products, resin infiltration, fissure sealant, atraumatic restorative treatment, resin composite restoration, and stainless steel crown (SSC), but also extraction associated with orthodontic treatment of the permanent first molars (PFMs) was reported on. The AMSTAR criteria 2 was applied, where six studies were assessed as having critically low quality, two studies as having low quality, and nine studies as having moderate quality.

CONCLUSIONS

MIH is highly prevalent worldwide and has most likely a multifactorial aetiology. Different treatment approaches according to the degree of severity of lesion(s) are reported on. The quality of evidence produced by the available SRs was not favourable. More well-designed clinical trials and high standard systematic reviews are necessary to elucidate better MIH characteristics and treatment outcomes.

Knowledge, attitudes, and beliefs regarding molar incisor hypomineralization (MIH) amongst German dental students

BACKGROUND

Knowledge of molar incisor hypomineralization (MIH) has relevance for paediatric dentists.

AIM

To assess final-year German dental students' knowledge, attitudes, and beliefs regarding MIH.

MATERIALS AND METHODS

A previously validated questionnaire was posted to the 31 German dental schools. Demographic covariates as well as knowledge regarding diagnosis and prevalence, and attitudes and beliefs around aetiology and management were collected.

RESULTS

Twenty-two (71%) dental schools responded and a total of 877 students participated. Most (97%) were familiar with MIH and 88% were aware of the diagnostic criteria for MIH; however, only 42% knew how to implement them. One-third were able to identify MIH and 16% reported diagnostic confidence when doing so; 90% assumed the MIH prevalence to be <10%. Two-thirds of the respondents implicated genetic components as the main aetiological factor of MIH. Resin composite (60%) and preformed metal crowns (46%) were the dental materials most often suggested for restorative management. Almost all (98%) respondents were interested in receiving more clinical training.

CONCLUSION

German students were familiar with MIH; however, they reported low levels of knowledge and confidence regarding its prevalence and diagnosis. Standardized nationwide, up-to-date curricula should be implemented to educate future dentists in Germany.

Molar-incisor hypomineralization (MIH), dental fluorosis, and caries in rural areas with different fluoride levels in the drinking water

AIM

This study determined the prevalence of molar-incisor hypomineralization (MIH) and its association with dental fluorosis and caries in children living in rural areas in north-eastern Brazil who are exposed to residual fluoride (F) levels in the drinking water.

DESIGN

A census was carried out with 610 schoolchildren aged 6 to 12 years. The European Academy of Paediatric Dentistry criteria, Thysltrup and Fejerskov index, and World Health Organization index were used for diagnosis of MIH, dental fluorosis, and caries detection, respectively. The association between the outcome and exposure variables was determined by robust Poisson regression (P < .05).

RESULTS

Water F-levels varied from 0.06 to 1.98 ppm. MIH was not related to fluoride levels in the drinking water, but it showed an inverse and direct correlation with dental caries and fluorosis, respectively. Children with MIH had a higher DMFT, and severe MIH cases were most frequent in children with dental fluorosis.

CONCLUSION

Drinking water F-levels were not directly related to the occurrence of MIH in schoolchildren. The severity of MIH, however, was likely to be associated with dental fluorosis in areas with moderate to high fluoride levels in the drinking water.

A systematic review of the quality and scope of decision modelling studies in child oral health research

Background

Decision analytic models are often used in economic evaluations to estimate long-term costs and effects of treatment which span beyond the time-frame of a clinical trial, therefore providing a better understanding of the long-term implications of decisions that conventional trial-based economic evaluations fail to provide. This is particularly relevant for considering oral health interventions in children as treatments may affect adult oral health. However, in the field of child oral health there has not been an evaluation of the quality and scope of decision analytical models which extend into adulthood. The aim of this review is to examine the scope and quality of decision modelling studies, with horizons extending into adulthood, within the field of child oral health.

Methods

The following databases were searched: NHS Economic Evaluation Database (CRD York), MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, the Cochrane Library and Econlit. Full economic evaluations, in the field of child oral health, published after 1997 which included a decision model with a horizon that extended beyond the age of 18 years old were included. Included studies were appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by calibrated reviewers.

Results

Four hundred studies were identified, of which nine met the inclusion criteria. Of the nine, eight were cost-effectiveness models. The majority focussed on the prevention or management of dental caries. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 82% (median = 85%, range = 54–100%). Discounting of costs and performing an incremental analysis were noted as key methodological weaknesses. The mean percentage of applicable CHEERS criteria met by each study was 82% (median = 87%, range = 32–96%). Justifying the type of model, analytical methods used, and sources of funding were most commonly unreported.

Conclusions

There is a paucity of decision analytical models in the field of child oral health. Most of those that are available are of high methodological and reporting quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01680-3.

Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial

To evaluate the preventive effect of glass ionomer cement (GIC) against dental caries and posteruptive breakdown (PEB) on molars affected by molar incisor hypomineralization (MIH). In this randomized clinical trial, 77 children aged 5-9 years with at least 1 MIH-affected molar and without PEB or dentin caries lesions (n = 228) were included and randomly allocated to one of the following groups: (1) MIH-affected molars that remained unsealed and (2) MIH-affected molars that received GIC sealants. Dental caries and PEB were clinically evaluated after 6 and 12 months. Associations between dental caries and PEB with independent variables were evaluated using logistic regression analysis (p < 0.05). The MIH-affected molars allocated to the GIC sealant group were less likely to develop dental caries compared to those allocated to the unsealed group (OR = 0.23; 95% CI 0.06-0.95). Conversely, application of a GIC sealant was not associated with prevention of PEB (p = 0.313). Furthermore, MIH-affected molars presenting yellow-brown opacities were almost 5 times more likely to develop dental caries (p = 0.013) and PEB (p = 0.001) compared to those presenting white-creamy opacities. We can conclude that GIC sealants can prevent dental caries on MIH-affected molars; however, the same protective effect was not observed for PEB.