A practical method for use in epidemiological studies on enamel hypomineralisation

Computerised assessment-a novel approach for calculation of percentage of hypomineralized lesion on incisors and its correlation with aesthetic concern

Introduction

Molar-incisor hypomineralization (MIH) is a localized, qualitative, demarcated enamel defect that affects first permanent molars (FPMs) and/or permanent incisors. The aim of present study was to introduce a novel computerised assessment process to detect and quantify the percentage opacity associated with MIH affected maxillary central incisors.

Methodology

Children (8-16 years) enrolled in the primary study having mild (white/cream or yellow/brown) MIH lesion on fully erupted maxillary permanent central incisor. 50 standardised images of MIH lesions were captured in an artificially lit room with fixed parameters and were anonymized and securely stored. Images were analysed by AI-driven computerised software and generates output classifications via a sophisticated algorithm crafted using a meticulously annotated image dataset as reference through supervised machine learning (SML). For the validation of computerised assessment of MIH lesions, the percentage of demarked opacity was calculated using ADOBE PHOTOSHOP CS7.

Results

The percentage of MIH lesion was calculated through histogram plotting with the maxima ranging from 7.29 % to 71.21 % with the mean value of 34.51 %. The validation score ranged from 10.29 % to 67.27 % with the mean value of 35.32 %. The difference between the two was statistically not significant. Out of 50 patients; 11 patients had 1-30 % of surface affected with MIH and 2 had aesthetic concern; 24 had 30-60 % of surface affected and 13 had aesthetic concern; 15 had >60 % of surface affected and 12 had aesthetic concerns.

Conclusions

The proposed approach exhibit sufficient quality to be integrated into a dental software addressing practical challenges encountered in daily clinical settings.

Optical coherence tomography and gray scale digital analysis as noninvasive techniques for evaluating molar-incisor hypomineralization severity: A comparative study with microcomputed tomography

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel characterized by demarcated opacities present in permanent first molars and other teeth. It is considered a major clinical challenge in dentistry because it makes affected teeth more susceptible to fractures and dental caries. Its diagnosis is mainly clinical and there are few technological resources that allow for a more accurate diagnosis, especially with respect to the depth of the defect in the dental enamel. In this context, optical coherence tomography (OCT), which is routinely used in ophthalmology, can produce images of the depth of the dental enamel, making it a promising method. In this study, 33 teeth with different MIH severities were evaluated using OCT and microcomputed tomography (microCT). Semi-quantitative methods of grayscale pattern analysis were used to compare images obtained from different severities of MIH with the mineral density obtained through microCT. MicroCT evaluation revealed that hypomineralized enamel had a significantly lower mineral density than intact enamel. However, this difference was not observed between the mild and severe MIH lesions. In the OCT evaluation, significant differences were observed between the intact and hypomineralized enamel, and the gray value comparison provided a method for quantitative differentiation between the two. This study suggests that OCT could be a useful adjunct to traditional diagnostic methods for MIH, offering a noninvasive approach to evaluate enamel defects. RESEARCH HIGHLIGHTS: Combining optical coherence tomography with grayscale digital analysis shows potential as a promising method for diagnosing molar-incisor hypomineralization and assessing its level of severity.

Analysis of the stomatognathic system functions and mastication muscles in children affected by molar hypomineralization (MH): a cross-sectional study

PURPOSE

To analyze the functions of the stomatognathic system in children with or without molar-incisor hypomineralization (MIH).

METHODS

For this cross-sectional study, 72 children aged 6-12 years were recruited and divided in two groups: with MIH (G1) and without MIH (G2). T-SCAN was used to verify the distribution of occlusal contacts, gnathodynamometer to measure maximum molar bite force, and Iowa Oral Pressure Instrument (IOPI) to assess the strength of facial expression muscles. The t test and paired t test (p ≤ 0.05) were used for statistical comparisons.

RESULTS

The molars affected by MIH exhibited lower distribution of occlusal forces (p < 0.001) and lower maximum molar bite force (p < 0.05) compared to the molars in the control group. However, there was no difference between the MIH-affected sides compared to the unaffected side, nor between the molars affected by MIH and their antagonists (p > 0.05). There were no differences in the forces of the facial expression muscles between the groups.

CONCLUSIONS

These findings suggest that MIH significantly impacts occlusal force distribution and bite force, but not facial expression musculature.

Which are the clinical consequences of Molar Incisor hypomineralization (MIH) in children and adolescents? Systematic review and meta-analysis

OBJECTIVE

This systematic review was conducted to address the following research question: "What are the clinical consequences (outcome) of Molar Incisor Hypomineralization (MIH) (exposure) in children and adolescents (population/patient)?".

MATERIAL AND METHODS

After defining the strategy, a search was performed in different databases (MEDLINE via Pubmed, Cochrane Library, BBO, LILACS, Scopus, Web of Science, Embase) and Grey literature in August 2023. Cross-sectional observational studies that identified clinical consequences of MIH (dental caries, post-eruptive structural loss, atypical restorations, hypersensitivity and tooth extraction) were included. The risk of bias was assessed following the Joanna Briggs Institute protocol for cross-sectional studies. Meta-analyses were conducted for each outcome, taking into account the number of patients and teeth. The effect measure considered was the prevalence; random-effects model was adopted. Heterogeneity was assessed using I2 statistics and prediction intervals (PI).

RESULTS

A total of 903 studies were identified; 41 were selected for qualitative analysis and 38 for quantitative analysis. Twenty eight studies were classified as presenting uncertain risk of bias, 11 as low risk and 3 as high risk of bias. The prevalence levels, ranked from highest to lowest and considering the tooth and patient units, respectively, were: caries lesions (0.252 - 95% CI 0.158-0.375; 0.512 - 95% CI 0.385-0.639); hypersensitivity (0.286 - 95% CI 0.190-0.407; 0.417 - 95% CI 0.197-0.674), post-eruptive fracture (0.125 - 95% CI 0.099-0.158; 0.257 - 95% CI 0.145-0.412); atypical restorations (0.048 - 95% CI 0.030-0.077; 0.167 - 95% CI 0.096 - 0.274); tooth extraction (0.012 - 95% CI 0.007-0.019; 0.090 - 95% CI 0.019 - 0.331). All meta-analyses resulted in heterogeneity greater than 85%, with the exception of the outcome "tooth extraction" according to the tooth unit (I2 = 57.83). This heterogeneity may be attributed to factors such as differences in the location where the study was realized, the socioeconomic conditions of the studied population, the asymmetric nature of MIH, and patient age.

CONCLUSION

The most common consequences of MIH are caries lesions, hypersensitivity, and post-eruptive breakdown. (PROSPERO:CRD42020201410).

Association of defects of enamel with polymorphisms in the vitamin D receptor and parathyroid hormone genes

This cross-sectional study aimed to investigate the association between developmental defects of enamel (DDE) and single nucleotide polymorphisms (SNPs) in the genes encoding the vitamin D receptor (VDR) and parathyroid hormone (PTH). Orthodontic patients receiving treatment at a dental school were selected through convenience sampling. Intra-oral photographs were used to assess DDE, which were classified according to the criteria proposed by Ghanim et al. (2015) by a single calibrated examiner (Kappa>0.80). Enamel hypoplasia, molar-incisor hypomineralization (MIH), hypomimineralized second primary molar (HSPM), and non-MIH/HSPM demarcated opacities were considered for the analysis. Genomic DNA was extracted from buccal cells. The SNPs in VDR (rs7975232) and PHT (rs694, rs6256, and rs307247) were genotyped using real-time polymerase chain reactions (PCR). Statistical analyses were performed using the PLINK software (version 1.03, designed by Shaun Purcell, EUA). Chi-square or Fisher's exact tests were performed at a significance level of 5%. Ninety-one (n=91) patients (49 females and 42 males) (mean age of 14.1±5.8 years) were included. The frequency of DDE was 38.5% (35 patients). Genotype distributions were in Hardy-Weinberg equilibrium. No significant statistical association was found between DDE and the SNPs evaluated. A borderline association (p=0.09) was observed between DDE and the CC haplotype for SNP rs7975232 in VDR. In conclusion, the selected SNPs in VDR and PTH genes were not associated with DDE in the studied samples.

Molar-incisor hypomineralization in a cohort of individuals born with cleft lip and palate

OBJECTIVE

This study aimed to investigate the frequency of molar-incisor hypomineralization (MIH) in individuals born with cleft lip and or cleft palate.

SETTINGS AND SAMPLE

Three hundred eighty-six individuals born with cleft lip and/or palate before orthodontic treatment.

METHODS

All the individuals were submitted to a clinical examination and intraoral standardized photos. The registration of MIH was taken by two orthodontists and analysed in association with the cleft type and laterality. The Kruskal-Wallis test and the regression test were used to compare the frequency of molars and incisors affected according to cleft type and laterality, sex and age.

RESULTS

We found a frequency of 67.87% of MIH in the studied sample. The frequency varied from 25% (in individuals born with cleft palate) to 77% in individuals born with bilateral cleft lip and palate). The number of affected molars was statistically different depending on cleft type and laterality (P < .001- Kruskal-Wallis test). Differences were found between individuals born with unilateral cleft lip and palate and unilateral cleft lip and alveolus (P = .03), and with isolated cleft palate (P = .03), and between individuals born with bilateral cleft lip and palate and born with unilateral cleft lip and alveolus (P = .01), and cleft palate (P = .01). Sex (P = .21) and age (P = .36) had no influence on the frequency of MIH. A positive correlation was found between the number of molars affected and incisors affected (P < .001).

CONCLUSION

Individuals born with cleft lip and palate have a higher frequency of MIH, and the complexity of cleft type was associated with the number of affected molars.

Caries experience in children with molar-incisor hypomineralisation in Fujairah, United Arab Emirates and its association with hypomineralised teeth number

BACKGROUND

Molar-incisor hypomineralisation (MIH) has been found associated with an increase in dental caries. Studies utilising the recent MIH diagnosis and calibration criteria recommended by the EAPD in 2021 are very scarce. Additionally, the available data in literature about the relationship between the hypomineralised teeth number (HTN) and caries come from only one study.

PURPOSE

To assess the relationship between MIH and caries experience among children in the city of Fujairah, UAE, utilising the recent criteria recommended by the European Academy of Paediatric Dentistry (EAPD) in 2021, and to assess the relationship between the number of teeth affected with MIH, and dental caries.

METHODS

One hundred and sixty-two children were included in this cross-sectional study, aged 7-9 years old. Children were examined for MIH according to Ghanim et al. (Eur Arch Paediatr Dent 16:235-246, 2015. 10.1007/s40368-015-0178-8) criteria and Ghanim et al. (Eur Arch Paediatr Dent 18:225-242. 10.1007/s40368-017-0293-92017) training manual. Caries experience was assessed with decayed, missing, filled (dmft, DMFT) scoring system.

RESULTS

dmft mean was 6.56 (SD ± 3.78) and DMFT mean was 0.91 (SD ± 1.23). Children with MIH had significantly higher dmft (p = 0.003) scores. Children with higher HTN had significantly higher dmft (p = 0.008) scores.

CONCLUSION

Children in Fujairah have extremely high caries scores. Children with MIH have more decayed, missing and filled teeth. Hypomineralised teeth number was positively associated with caries experience.

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.

Prevalence and clinical presentation of molar incisor hypomineralisation among a population of children in the community of Madrid

OBJECTIVE

The main objective of this study was to estimate the prevalence of molar incisor hypomineralisation (MIH), an alteration of tooth enamel with an estimated worldwide prevalence rate of 14%, among children using primary care services in the Community of Madrid, Spain.

MATERIALS AND METHODS

This was a descriptive, cross-sectional and multicentre study. After calibrating all researchers and following the diagnostic criteria of the European Academy of Paediatric Dentistry (EAPD), children aged between 8 and 16 years who were users of the dental services at 8 primary oral health units of the Madrid Health Service (SERMAS) were included. The children underwent a dental examination, and the parents were asked to complete a questionnaire.

RESULTS

The prevalence of MIH was 28.63% (CI: 24.61-32.65%). The age cohorts most affected by MIH were 8 years (21.4%) and 11 years (20.7%). The presence of MIH was greater among girls (85; 60.71%) than among boys (55; 39.28%). The mean number of affected teeth per patient was 4.46 ± 2.8. The most frequently affected molar was the upper right first molar (74.3%), and the upper left central incisor was the most affected incisor (37.85%). Opacities were the defects most frequently recorded (63.57%).

CONCLUSIONS

The prevalence of MIH in this study is the highest of all relevant studies conducted in Spain.

The Impact of Molar Incisor Hypomineralisation on Children and Adolescents: A Narrative Review

Molar incisor hypomineralisation (MIH) is a qualitative developmental enamel defect with a prevalence of 13% worldwide. This review aims to outline the current evidence regarding the impact of MIH on children's oral health and, more broadly, their day-to-day activities. MIH is associated with negative sequelae, including hypersensitivity, post-eruptive breakdown, the rapid development of carious lesions and poor aesthetics. Other concerns pertain to the clinical management of MIH and include difficulty in achieving local anaesthesia, increased dental fear and anxiety (DFA) and increased behaviour management problems. Oral health-related quality of life (OHRQoL) is the most standardised measure of patient impact; however, no instruments have been validated for use in MIH populations. The few existing observational studies investigating the impact of MIH on OHRQoL in children have produced conflicting results. Interventions to alleviate hypersensitivity and improve aesthetics had a positive impact on the OHRQoL of MIH-affected children. Multiple methodological issues make it difficult to measure the impact of MIH, including heterogeneity in the MIH severity classification, an overlap in the indices used to diagnose dental caries and MIH as well as the subjectivity of outcome measures for hypersensitivity and DFA.

Development of undergraduate students' diagnostic accuracy for the classification of molar incisor hypomineralization

INTRODUCTION

One of the major difficulties with respect to molar incisor hypomineralization (MIH) is its classification and differentiation from other enamel development defects (EDDs). The aim of this study was to evaluate diagnostic accuracy in dental students to classify MIH as well as its differentiation from other EDDs by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

METHODS

In this one-group pre-test and post-test study, 59 second-year students assessed 115 validated photographs using the MIH Index on the Moodle learning platform. This index assesses the clinical features and extent of MIH, differentiating it from other EDDs. Students received automatic feedback after the pre-test. Two weeks later, students re-evaluated the same photographs. Both pairwise accuracy and overall diagnostic accuracy were estimated and compared for pre- and post-testing, with the area under the curve AUC, along with 95% confidence intervals (95% CI).

RESULTS

The lowest diagnostic accuracy was for the ability to discriminate between white or cream-coloured demarcated opacities and hypomineralization-type defect that is not MIH. The overall pre-test accuracy was AUC = 0.83 and increased significantly post-test to AUC = 0.99 (p < .001). The overall accuracy to discriminate the extent of the lesion also increased significantly post-test (p < .001).

CONCLUSION

Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

The association between serum vitamin D status and dental caries or molar incisor hypomineralisation in 7-9-year-old Norwegian children: a cross-sectional study

BACKGROUND

Research focusing on the association between serum vitamin D and oral health outcomes in children, such as dental caries and molar incisor hypomineralisation (MIH), shows inconsistent results. Previous studies have predominantly investigated dental caries and MIH as dichotomized outcomes, which limits the information on their distribution. In addition, the methods used for analysing serum vitamin D have varied. The present study aimed to investigate potential associations between serum vitamin D status measured by Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS) and the prevalence, as well as the number of teeth, affected by dental caries or MIH among 7-9-year-old Norwegian children.

METHODS

The study had a cross-sectional design and included 101 children aged 7-9 years. Serum 25-hydroxyvitamin D (25(OH)D) was measured and included as continuous (per 25 nmol/l) and categorised (insufficient (< 50 nmol/l) and sufficient (≥50 nmol/l)) exposure variables. Adjusted negative binomial hurdle models were used to investigate the potential associations between serum vitamin D and the oral health outcomes (dental caries and MIH) adjusted for sex, age, body mass index, season of blood draw, and mother's educational level.

RESULTS

Of the 101 children in the total sample, 27% had insufficient vitamin D levels (< 50 nmol/l). The descriptive analysis indicated that the children with insufficient vitamin D levels had a higher prevalence (33.3%) and a higher number of teeth affected by dental caries (mean (SD) = 0.7 (1.4)), compared to children with sufficient levels of vitamin D (21.6% and mean (SD) = 0.4 (0.8), respectively). The same holds for MIH, with a higher prevalence (38.5%) and a higher number of teeth affected (mean (SD) = 1.2 (2.3)), compared to children with sufficient levels of vitamin D (30.1% and mean (SD) = 0.8 (1.6), respectively). However, in the adjusted hurdle model analysis, neither the prevalence or number of teeth affected by caries or MIH showed statistically significant associations with having insufficient or lower vitamin D levels.

CONCLUSIONS

Vitamin D status was not significantly associated with the prevalence and number of teeth affected by caries and MIH among the participating children. Large prospective studies with multiple serum vitamin D measurements and oral examinations throughout childhood are warranted to elucidate the relationship.

Molar incisor hypomineralization and oral health-related quality of life: a sample of 8-12-years-old children

OBJECTIVES

The study aimed to evaluate the impact of molar incisor hypomineralization (MIH) and tooth sensitivity on the oral health in terms of the quality of life (OHRQoL). In addition, the impact of tooth maturity on tooth sensitivity was evaluated in the study.

MATERIALS AND METHODS

Children aged 8-12 years with and without MIH participated in this descriptive cross-sectional study. They were chosen through the convenience sample technique. The Pediatric-Oral-Health-related-Quality-of-Life (POQL) scale was used to assess OHRQoL. The presence of the MIH and decayed, filled and missing teeth due to caries (using dmft/s, DMFT/S indexes) were recorded. The tooth sensitivity and dental maturity status were evaluated with the Shiff-Cold-Air-Sensitivity-Scale (SCASS) and Demirjian-method, respectively. Statistical analysis of the data was performed by Pearson Chi-Square Test and Mann-Whitney U test (p<0.05).

RESULTS

In this study, the participants were a total of 260 children, half were affected by the MIH. Their mean POQL scores were higher than those of the children without MIH with a statistically significantly difference in the total child scale score (p=0.014). Among the children with the MIH, child total QoL score was found to be higher in SCASS positive response group (p=0.011). The teeth with MIH (p<0.001) showed higher response to the stimulus. According to the dental age and dental maturity categories of the children with MIH, the total child scale score was found to be higher in the SCASS category (p=0.011), and the response status to the SCASS was statistically significant (p=0.042 and p=0.05, respectively).

CONCLUSIONS

Among the children with MIH, the OHRQoL was found to be negatively affected. The teeth with the MIH tend to reveal more tooth sensitivity than healthy teeth. Many conditions such as having MIH, and tooth sensitivity might have an impact on the OHRQoL. In addition, more sensitivity to the stimulus was observed in the teeth with lower tooth maturity status; the dental age and dental maturity might have effects on tooth sensitivity.

CLINICAL RELEVANCE

Considering the negative impacts due to MIH, the evaluation of OHRQoL is critical for dentists to employ a well-defined guide in their clinical decisions.

Caries Detection in Primary Teeth Using Intraoral Scanners Featuring Fluorescence: Protocol for a Diagnostic Agreement Study

BACKGROUND

Digital methods that enable early caries identification can streamline data collection in research and optimize dental examinations for young children. Intraoral scanners are devices used for creating 3D models of teeth in dentistry and are being rapidly adopted into clinical workflows. Integrating fluorescence technology into scanner hardware can support early caries detection. However, the performance of caries detection methods using 3D models featuring color and fluorescence in primary teeth is unknown.

OBJECTIVE

This study aims to assess the diagnostic agreement between visual examination (VE), on-screen assessment of 3D models in approximate natural colors with and without fluorescence, and application of an automated caries scoring system to the 3D models with fluorescence for caries detection in primary teeth.

METHODS

The study sample will be drawn from eligible participants in a randomized controlled trial at the Royal Children's Hospital, Melbourne, Australia, where a dental assessment was conducted, including VE using the International Caries Detection and Assessment System (ICDAS) and intraoral scan using the TRIOS 4 (3Shape TRIOS A/S). Participant clinical records will be collected, and all records meeting eligibility criteria will be subject to an on-screen assessment of 3D models by 4 dental practitioners. First, all primary tooth surfaces will be examined for caries based on 3D geometry and color, using a merged ICDAS index. Second, the on-screen assessment of 3D models will include fluorescence, where caries will be classified using a merged ICDAS index that has been modified to incorporate fluorescence criteria. After 4 weeks, all examiners will repeat the on-screen assessment for all 3D models. Finally, an automated caries scoring system will be used to classify caries on primary occlusal surfaces. The agreement in the total number of caries detected per person between methods will be assessed using a Bland-Altman analysis and intraclass correlation coefficients. At a tooth surface level, agreement between methods will be estimated using multilevel models to account for the clustering of dental data.

RESULTS

Automated caries scoring of 3D models was completed as of October 2023, with the publication of results expected by July 2024. On-screen assessment has commenced, with the expected completion of scoring and data analysis by March 2024. Results will be disseminated by the end of 2024.

CONCLUSIONS

The study outcomes may inform new practices that use digital models to facilitate dental assessments. Novel approaches that enable remote dental examination without compromising the accuracy of VE have wide applications in the research environment, clinical practice, and the provision of teledentistry.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12622001237774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384632.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51578.

Characterization of enamel developmental defects in patients with orofacial clefts and their relationship to surgical procedures

AIMS

This study aimed to characterize the prevalence of development defects of enamel (DDE) in patients with cleft based on the cleft phenotype and explore the relationship between surgical procedures and different types of DDE.

MATERIAL AND METHODS

In this cross-sectional study, 290 standardized orthodontic documentation and medical records from a reference hospital were evaluated, which treated patients with: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), cleft palate (CP), cleft median (CM), and considering laterality as unilateral or bilateral. DDE was assessed using the Ghanim Index (2015). Information on surgical intervention periods was obtained from medical records. Statistical analyses were performed using prevalence ratio (PR) for DDE comparisons between cleft phenotypes and surgical procedures.

RESULTS

The prevalence of DDE was 77.2%. Demarcated hypomineralization was associated with CP and CLP, while hypoplasia was associated with CLa, especially when bilateral. Hypoplasia was also associated with the labial adhesion surgery.

CONCLUSION

Demarcated hypomineralization was the most common DDE in this population, and the cleft phenotype influenced the type of DDE manifested. The lip adhesion surgery increased the chances of hypoplasia manifestation.

CLINICAL RELEVANCE

The type of DDE in patients with cleft depends on the cleft phenotype. Understanding this susceptibility enables the multidisciplinary team to monitor dental development, thus allowing early diagnosis and timely referral to the pediatric dentist and better prognoses.

Effect of Prevalence and Severity of Molar-Incisor Hypomineralization on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis

Objectives

The aim of this systematic review and meta-analysis is to assess the association between the MIH presence as well as the severity and OHRQoL in children.

Material and methods

Relevant studies were identified in PubMed, Embase, Cochrane and Google Scholar. Studies involving MIH and OHRQoL in children were included. A methodological quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) and its adapted version for cross-sectional studies. Random effects models were used to estimate summary effect measures for the association between MIH presence (presence vs. absence) as well as severity (moderate/severe MIH vs. no MIH) and OHRQoL using generic inverse variance meta-analyses. Tests for heterogeneity, publication bias and sensitivity of results were also performed.

Results

Out of 1696 identified publications 11 studies reporting on 5,017 children were included in the meta-analysis assessing the impact of MIH presence. There was no statistically significant association between the presence of MIH and lower OHRQoL in affected children (OR = 1.72, 95% CI = 0.99-2.98). Concerning MIH severity and its impact on OHRQoL, a sum of 6 studies were included in the meta-analysis involving a total of 2,595 children. There was a significant association between moderate/severe MIH and lower OHRQoL in affected children (OR = 3.43, 95% CI = 1.69-6.98).

Conclusion

Moderate/Severe MIH has a significant and clinically relevant negative impact on OHRQoL, and it should therefore be addressed adequately. Future research should also consider the impact of a uniform MIH diagnosis and precise severity criteria.

Comparison between two molar incisor hypomineralization detection criteria in epidemiological surveys

BACKGROUND

There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys.

AIM

To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH-Severity Scoring System (MIH-SSS) in classifying and diagnosing MIH.

DESIGN

This cross-sectional study assessed the indices in a homogeneous group of 680 6- to 10-year-old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations.

RESULTS

The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH-SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH-SSS (chi-squared test; p < .01). The MIH-SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p < .05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%.

CONCLUSION

All systems effectively diagnosed MIH and its characteristics.

Comparison between intraoral scanning and direct visual analysis for the assessment of developmental defects of enamel

OBJECTIVE

To compare direct visual analysis (DVA) and intraoral scanning (IOS) for the assessment of developmental defects of the enamel (DDE).

METHODS

Thirty-nine extracted permanent human teeth with DDE were selected by an experienced examiner and digitised using IOS. The scanning was recorded using the OBS Studio software parallel to the IOS software to obtain a coloured high-definition MP4 file of the process. Two other experienced, blinded, and calibrated examiners randomly analysed the same teeth through DVA and IOS. A third examiner resolved any disagreements between the two examiners. Descriptive statistics were used to analyse the frequencies of the scores. Cohen's kappa test was used to determine whether the DVA scores were different from those assigned using IOS. Spearman's test was used to verify non-random examiner errors. The Chi-square test was used to compare score frequencies. Statistical significance was set at p <0.05.

RESULTS

Scores indicating more severe and extended DDE (p <0.05) were more frequently assigned with IOS than with DVA (IOS: 25.64%, 25.64%, 38.46%, and 35.90% between one-third to two-third of the lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 10.26%, 7.69%, 15.38%, and 10.26% for the respective aforementioned tooth surfaces). Contrarily, 'no visible enamel defect' was significantly less assigned for IOS than for DVA (IOS: 15.38%, 43.59%, 35.90%, 15.38%, and 17.95% for buccal, lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 38.46%, 66.67%, 56.41%, 51.28%, and 43.59% for the respective aforementioned tooth surfaces). Kappa agreement ranged from fair to moderate when comparing DVA and IOS; the correlation between both methods was positive, indicating that the examiners assigned the scores properly and the differences arose from employing different methods.

CONCLUSION

The assessment of DDE differed depending on the method used. IOS scores indicated more severe and extended DDE than DVA scores. Clinical investigation is the next step in validating the use of IOS for DDE diagnosis.

CLINICAL SIGNIFICANCE

This study showed that DDE can be assessed differently using IOS. It is clinically relevant as it directly affects the determination of the severity of the defect and dental treatment planning.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10 years old children: A systematic review and meta-analysis

OBJECTIVES

This study aimed to evaluate the impact of molar incisor hypomineralization (MIH) and its different severities on various aspects of oral health-related quality of life (OHRQoL) in children between 8 and 10 years of age.

DATA SOURCES

The search terms were chosen according to the Medical Subject Headings (MeSH) and non-MeSH. Potentially eligible studies involved the OHRQoL evaluation in 8-10 years old children with MIH. An electronic search of published studies was carried out in August 2022 on Scopus, Web of Science, and PubMed databases. Of 130 papers retrieved initially, 21 were eligible to be included in the systematic review, of which 8 were excluded. The OHRQoL questionnaires used in the studies included Caregivers Perceptions Questionnaire (CPQ) 8-10, Child Oral Health Impact Profile questionnaire, and Child Oral Impacts on Daily Performances questionnaire. Nine studies using CPQ8-10 contributed to the meta-analysis.

RESULTS

According to meta-analysis, the results revealed that in MIH children a significant increase was observed in the total score of CPQ 810 with the pooled mean of 15.89 (95% confidence interval [CI]:8.95-22.84; P-value = .001) and in oral symptoms, functional limitation and emotional well-being domains with the pooled means of 6.25 (95% CI:4.01-8.50; P-value = .001), 3.88 (95% CI:1.93-5.83; P-value = 0.001), and 3.24 (95% CI:0.96-5.52; P-value = .01), respectively. While the increase in social well-being with the pooled mean of 1.65 (95% CI: -0.47 to 3.76; P-value = .13) was not significant. Subgroup analysis based on MIH severity showed no significant difference in OHRQoL means for all variables.

CONCLUSION

Suffering from MIH, negatively affected the total score and all domains of the CPQ 8-10 questionnaire, except for social well-being. Furthermore, different severities of MIH had no significant impact on OHRQoL in children.

Prenatal exposure to persistent organic pollutants and molar-incisor hypomineralization among 12-year-old children in the French mother-child cohort PELAGIE

BACKGROUND

Exceptional episodes of exposure to high levels of persistent organic pollutants have already been associated with developmental defects of enamel among children, but knowledge is still scarce concerning the contribution of background levels of environmental contamination.

METHODS

Children of the French PELAGIE mother-child cohort were followed from birth, with collection of medical data and cord blood samples that were used to measure polychlorinated biphenyls (PCBs), organochlorine pesticides (OCs), and perfluorinated alkyl substances (PFASs). At 12 years of age, molar-incisor hypomineralization (MIH) and other enamel defects (EDs) were recorded for 498 children. Associations were studied using logistic regression models adjusted for potential prenatal confounders.

RESULTS

An increasing log-concentration of β-HCH was associated with a reduced risk of MIH and EDs (OR = 0.55; 95% CI, 0.32-0.95, and OR = 0.65; 95% CI, 0.43-0.98, respectively). Among girls, intermediate levels of p,p'-DDE were associated with a reduced risk of MIH. Among boys, we observed an increased risk of EDs in association with intermediate levels of PCB 138, PCB 153, PCB 187, and an increased risk of MIH with intermediate levels of PFOA and PFOS.

CONCLUSIONS

Two OCs were associated with a reduced risk of dental defects, whereas the associations between PCBs and PFASs and EDs or MIH were generally close to null or sex-specific, with an increased risk of dental defects in boys. These results suggest that POPs could impact amelogenesis. Replication of this study is required and the possible underlying mechanisms need to be explored.

MIH and Dental Caries in Children: A Systematic Review and Meta-Analysis

(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and MIH in children. (2) Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. (3) Results: 59 papers published between 2007 and 2022 were included in the qualitative synthesis and 18 in the meta-analysis. The total sample of subjects was 17,717 (mean: 896), of which 2378 (13.4%) had MIH (mean: 119), with a girl/boy ratio of 1:1. The mean age of the enrolled participants was 8.6 (age range 7-10 years). Meta-analysis showed that MIH has a positive correlation with both dmft (effect size of 0.67, 95% CI [0.15, 1.19]) and DMFT (effect size of 0.56, 95% CI [0.41, 0.72]); (4) Conclusions: Children with MIH should be diagnosed correctly and on time. Treatment and management options for moderate and severe forms of MIH should consider prognosis based on known risk factors, and secondary and tertiary prevention policies should also consider the multifactorial nature of caries etiology.

Prevalence and clinical characteristics of molar-incisor hypomineralization in Syrian children: a cross-sectional study

This study was undertaken to determine the prevalence of molar incisor hypomineralization (MIH) in Syrian children and to provide information about clinical patterns and severity of MIH lesions. A sample of 1138 children aged 8-11 years was recruited for this cross-sectional study. The diagnosis of MIH was made using the criteria of the European Academy of Paediatric Dentistry (EAPD) and the MIH/HPSMs short charting form was used to score the index teeth. The results showed that the prevalence of MIH in Syrian children was 39.9%. Demarcated opacities were the most prevalent pattern of MIH defects on Permanent first molars (PFMs) and permanent incisors (PIs). Spearman rank correlation showed that the mean number of PIs and HPSMs with MIH increased when the number of affected PFMs was increased (P < 0.001). Chi-square test resulted that girls showed a higher number of severe PFMs than boys did with a statistically significant difference (x² = 133.1, P < 0.05). Moreover, Chi-square test showed that the number of severe PFMs is higher than the number of severe PIs with a statistically significant difference (x² = 54.9, P < 0.05). In addition, the mean dmft/DMFT index in children with MIH was found to be significantly higher than children without MIH (P < 0.05). The findings emphasize the need for early identification and management of MIH in children to prevent adverse effects on their oral health.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH)

AIM

The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH.

METHODS

For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS).

RESULTS

MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age.

CONCLUSION

No association was found between dental fear and dental hypersensitivity in children with MIH.

Developmental enamel defects and their relationship with caries in adolescents aged 18 years

Randomly selected 1,611 individuals aged 18 years formed a nationally representative sample from all provinces of Poland. Developmental defects of the enamel (DDE) and caries were assessed using the modified DDE index, molar incisor hypomineralisation (MIH) Treatment Need Index (MIH-TNI), FDI and WHO criteria by 22 trained and calibrated dentists. T-test was used for comparing group means. A simple and multiple logistic regression tests were used to assess the relationship between DDE and caries severity expressed as DMFT (p < 0.05). The prevalence of DDE was 13.7%. Demarcated opacities (DEO) were the most frequent (9.65%); 4% had diffuse opacities (DIO) and 1.5% had hypoplasia. MIH was diagnosed in 0.6% patients. The prevalence of caries was 93.2%, with mean DMFT of 6.50 ± 4.22. The DMFT value was 7.52 ± 4.77 in the group of patients with demarcated opacities (DEO); 7.85 ± 4.74 with diffuse opacities (DIO) and 7.56 ± 4.57 with enamel hypoplasia, respectively. There was a significant relationship between caries severity and DDE (p < 0.001), DEO (p = 0.001) and DIO (p = 0.038), and between DDE and DMFT index (p < 0.001). The results obtained in the study proved the significant relationship between DDE and DMFT in 18-year-olds, the assessment of which was the aim of the study.

Molar Incisor Hypomineralization in adolescents and adults and its association with facial profile and occlusion

OBJECTIVES

To date, there are no data available in the scientific literature about the diagnosis of Molar Incisor Hypomineralization (MIH) in adults. We aimed to assess the MIH prevalence and clinical characteristics in adolescents and adults and its association with facial profile and occlusion.

MATERIALS AND METHODS

In this cross-sectional study, permanent teeth were evaluated in 275 patients between the ages of 12 and 49 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index. Statistical analyses were performed using chi-square, Fisher's tests, and ordinal logistic regression.

RESULTS

MIH was observed in 12.73% of all patients. The most commonly affected teeth were permanent molars, while incisors, premolars, and canines were less affected. MIH usually appears as demarcated opacities, with less than one-third of the tooth affected. There was no association between severe defects and facial profile and occlusion, but rather with the higher age of the participants.

CONCLUSION

Enamel hypomineralization mainly affects the first and second permanent molars, but it could also be observed in the third molars, although it is not associated with the orthodontic characteristics investigated.

CLINICAL RELEVANCE

This is the first study to highlight the prevalence of MIH in adults. This result showed the importance of other specialists beyond Pediatric Dentistry in the diagnosis of this defect. In addition, hypomineralization of other permanent teeth (canines, premolars, and second molars) has been described previously in other studies, but this is the first to identify MIH in third molars.

Electromyographic analysis of the stomatognathic system of children with Molar-incisor hypomineralization

INTRODUCTION

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel that affects one or more permanent first molars, with or without involvement of the incisor teeth. This condition leads to challenges to dental care and treatment planning.

AIM

Based on the hypothesis that children who have MIH possibly present alterations in postural and masticatory activities and considering the absence of studies investigating these parameters, the present study evaluated the functionality of the stomatognathic system considering the mentioned aspects.

MATERIALS

The comparison of individuals with (MIHG; n = 32) and without MIH (CG; n = 32) was evaluated by electromyographic activity of the masseter and temporal muscles (right and left), as well as evaluation of the masticatory cycles during habitual mastication.

RESULTS

MIHG showed muscle hyperactivity in postural and dynamic conditions compared to the CG; higher electromyographic values for MIHG when compared to CG in the following postural conditions: at rest for the right temporal (p = 0.00) and left temporal muscles (p = 0.03); in the protrusion to the right temporal muscle (p = 0.02); in the right laterality for the right masseter (p = 0.00) and left temporal muscles (p = 0.01); in the left laterality for the right masseter (p = 0.03) and left temporal (p = 0.04) muscles. In dynamic conditions with consistent food, significance was observed for the left temporal (p = 0.01); and with soft food for the right (p = 0.01) and left temporal muscles (p = 0.04).

CONCLUSIONS

Children with MIH seem to have impaired functionality of the stomatognathic system. Children with MIH have alterations in the stomatognathic system.

Molar-incisor hypomineralisation prevalence in a cohort of Australian children with type 1 diabetes

PURPOSE

Systemic diseases or drugs administered early in life may cause a disruption in amelogenesis and contribute to the qualitative defect of enamel described as molar-incisor hypomineralisation (MIH). Therefore, an increase in prevalence of MIH in children with type 1 diabetes (T1D) may be expected as this systemic disorder is commonly diagnosed in early childhood. The aim of this study was to determine the prevalence of MIH in a cohort of children with T1D and investigate diagnosis of MIH with T1D factors.

METHODS

Cross-sectional study of children with T1D recruited from paediatric diabetes clinics at the Women's and Children's Hospital (South Australia). A detailed medical history, comprehensive dental and MIH examination according to the European Academy of Paediatric Dentistry (EAPD) long form classification was collected for each child. All upper and lower first permanent molars and central incisors were scored.

RESULTS

A total number of 73 participants; 35 (47.95%) males were examined including 584 teeth. The mean age of the participants was 13.25 ± 2.58 years, with a mean age of diagnosis 7.75 ± 3.58 years, and a mean HbA1c of 8.5 ± 1.6%. 42 out of 73 children (54.8%) had enamel defects on at least one of the teeth examined. However, 19.2% met the criteria for MIH. Univariate and bivariate analyses were conducted but no significant associations were noted between MIH and risk factors including diabetes control (p > 0.1).

CONCLUSION

There was a high prevalence of enamel defects and MIH amongst children with T1D. More research is required to establish association between T1D and MIH.

The prevalence and characteristics of and the association between MIH and HSPM in South-Western France

BACKGROUND

Molar-incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) involve qualitative structural developmental anomalies of tooth enamel, affecting the first permanent molars (FPM) and the second primary molars, respectively. This developmental anomaly of systemic origin has important consequences for oral health.

AIM

To determine the prevalence of MIH and HSPM in south-western France and explore the distribution of hypomineralised lesions on permanent and primary molars.

DESIGN

Amongst 856 children (aged 7-9 years) in schools randomly selected by the Academy of Bordeaux (Ministry of Education), the FPM, permanent incisors and the second primary molars were examined by two examiners trained and calibrated for the diagnostic criteria for MIH and HSPM of the European Academy of Paediatric Dentistry.

RESULTS

Molar-incisor hypomineralisation was present in 160 children (18.7%) and HSPM in 81 children (9.5%); 4.9% had both HSPM and MIH (42 of 856). Hypomineralised lesions were present in 1-4 FPM in affected individuals (mean = 2.4) and were distributed in an asymmetrical manner with widely varying severity at the tooth and individual level. A child with HSPM was more likely to have MIH than a child without HSPM (95% CI OR = 6.0 [3.7-9.7]; p < .0001).

CONCLUSION

Molar-incisor hypomineralisation and HSPM have three main asymmetrical characteristics: tooth location, severity of hypomineralisation and number of teeth affected.

Identification by whole-exome sequencing of new single-nucleotide polymorphisms associated with molar-incisor hypomineralisation among the Lebanese population

OBJECTIVE

Molar-incisor hypomineralization (MIH) is a developmental qualitative enamel defect, causing a worldwide challenging dental problem. The etiology of this defect remains unclear. Here we identify by whole-exome sequencing (WES) new single-nucleotide polymorphisms (SNPs) in genes expressed during enamel mineralization and in those modulating prenatal, natal and postnatal risk factors among the Lebanese MIH children: immune system and xenobiotic detoxification.

DESIGN

Dental examination for MIH was performed based on the MIH index for diagnostic criteria. Saliva samples were collected from 37 non-related, MIH-diagnosed subjects for DNA extraction. WES was performed on the Illumina HiSeq2000 platform. The χ² test and Fisher's exact test were used to determine relationship between SNPs frequencies and MIH. OR and its 95% CI were used to report the strength of association. The significance threshold was set at 0.05.

RESULTS

Among the Lebanese population, 37 SNPs presented a significant association with MIH in the following genes: AMTN, MMP-20, STIM1, STIM2, ORAI1, SLC34A2, SLC34A3, VDR, PVALB, HSP90B1, TRPM7, SLC24A4, CA6, SLC4A2, TNFRSF11A, IL10RB, ARNT, ESR1 and CYP1B1.

CONCLUSION

This is the first WES study conducted in patients with MIH. Yet, interactions between polymorphisms in different gene categories are to be investigated for a better assessment of MIH susceptibility.

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.

Are Molar-Incisor Hypomineralization and Hypomineralized Second Primary Molars Predictive of Dental Caries?: A Systematic Review

To estimate the prevalence of dental caries among children affected concomitantly with molar-incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM).Electronic databases, including Medline via PubMed, Cochrane Library, Scopus, and Science Direct, were searched. Studies written in English involving children with MIH-HSPM and dental caries were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk with the Newcastle-Ottawa Scale (NOS) criteria.Out of 535 studies identified in the initial research, only two articles were included in the present review. A significant association between MIH-HSPM and dental caries in permanent dentition was reported in the two included records (AOR: 3.70; p < 0.001). Children with MIH-HSPM expressed significantly higher DMFT and PUFA values than children without MIH-HSPM. However, dmft values did not differ significantly between children with and without HSPM (1.79 [2.4] vs. 1.78 [2.5]; 1.88 [2.73] vs. 1.59 [2.53], respectively.MIH-HSPM lesions were correlated with a higher prevalence and more severe carious lesions in permanent dentition. However, the results should be interpreted cautiously because the findings were generated by only two studies performed by the same authors. Thus, further well-designed studies are highly recommended.

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.

Vitamin D status and tooth enamel hypomineralization are not associated in 4-y-old children: An Odense Child Cohort study

Early fetal stages of tooth development are vitamin D-dependent, suggesting an impact of vitamin D status in pregnancy on tooth mineralization in human populations. We examined the association between pregnancy and cord serum 25-hydroxyvitamin D (s-25(OH)D) and hypomineralization of the second primary molars (HSPM) in the 4-year-old children in the prospective, population-based Odense Child Cohort, Denmark. S-25(OH)D was measured in early pregnancy (<20 weeks, n = 753); late pregnancy (≥20 weeks, n = 841); and in umbilical cord blood (n = 1,241) using liquid chromatography-tandem mass spectrometry. HSPM was scored using modified European Academy of Paediatric Dentistry judgment criteria. The median [Q1;Q3] s-25(OH)D was 65.0 [49.4;78.0], 79.2 [60.4;95.8], and 45.1 [31.2;60.5] nmol/L in early pregnancy, late pregnancy, and cord blood, respectively. The prevalence of HSPM was 54.7%; creamy/white demarcated opacities 79.5%; yellowish/brownish demarcated opacities 14.9%; post-eruptive breakdown 5.2%; atypical restoration 0.4%. No univariate or adjusted associations with HSPM were detected for pregnancy or cord s-25(OH)D as a continuous variable or categorized into quartiles or routine clinical cut-offs, or when classifying HSPM by severity. In exploratory multiple regression analysis, HSPM was inversely associated with the length of gestation, adjusted odds ratio (aOR) 0.82 (95% C.I 0.74-0.92, p < 0.001), and directly associated with maternal education, aOR 1.57 (95% C.I 1.18-2.08, p = 0.002). In a population with relatively high s-25(OH)D concentrations and generally healthy mothers and children, pregnancy and cord blood vitamin D status was not associated with HSPM. The associations between HSPM and shorter gestational length and higher maternal education warrant further study.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries

This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Tooth abnormalities associated with non-syndromic cleft lip and palate: systematic review and meta-analysis

OBJECTIVE

To evaluate the association between orofacial clefts (OFC) and tooth abnormalities (TA).

METHODS

We searched PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and BBO, and in the gray literature and selected observational studies that evaluated the association between TA and OFC. The risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed comparing the presence and absence of OFC, cleft type-cleft palate (CP) and cleft lip with or without palate (CL/P)-and cleft laterality-unilateral and bilateral. The certainty of evidence was evaluated using the GRADE approach.

RESULTS

A total of 99 studies were included in the qualitative analysis, and 37 were included in the meta-analysis. Only four studies were classified as low risk of bias. Significant associations were observed between the presence of OFC and tooth agenesis (OR = 19.46; 95%CI = 4.99-75.96), supernumerary teeth (OR = 4.04; 95%CI = 1.26-12.99), developmental defects of enamel (OR = 3.15; 95%CI = 1.28-7.80), microdontia (OR = 15.57; 95%CI = 1.06-228.51), and taurodontism (OR = 1.74; 95%CI = 1.74-2.86). Individuals with CP had a lower frequency of supernumerary teeth (OR = 0.22; 95%CI = 0.08-0.64), peg-shaped tooth (OR = 0.31; 95%CI = 0.12-0.80), and morphological TA (OR = 0.13; 95%CI = 0.04-0.45) than individuals with CL/P. No TA was significantly associated with cleft laterality (p > 0.05). The quality of the evidence was very low in all analyses.

CONCLUSION

Individuals with OFC had a higher frequency of TA than those without OFC. Individuals with CP had a lower frequency of TA than individuals with CL/P. No TA was associated to cleft laterality.

CLINICAL RELEVANCE

Help to identify the treatment needs of individuals affected by OFC, improving the services provided to this population.

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.

Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7-9 years of age: a longitudinal study

Purpose

The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children.

Methods

The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18–22 and 32–36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders.

Results

Among the children (7–9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18–22 and the number of affected teeth among those with MIH at 7–9 years (adjusted RR = 1.82, 95% CI 1.13–2.93).

Conclusion

Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7–9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00712-y.

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.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences

Background: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case–control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. Methods: For 150 mother–child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child’s adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. Conclusion: If structural changes in children’s teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.

Prevalence, Pattern, and Severity of Molar Incisor Hypomineralization in 8-12-year-old Schoolchildren of Moradabad City

Aim and objective

Recently, molar incisor hypomineralization (MIH) has become more evident and one of the most common reasons for loss of teeth in children after dental caries. Being a country with a diverse ethnic population, the prevalence of MIH in different regions of India may differ. Hence, the present study was undertaken to determine the prevalence, pattern, and severity of MIH in 8-12-year-old Schoolchildren in Moradabad city.

Materials and methods

This study was conducted in various schools of Moradabad city to target a sample of 2,300 children aged between 8 and 12 years. The examination was done in their respective schools by a calibrated examiner in natural daylight using European Academy of Pediatric Dentistry diagnostic criteria for MIH 2015. The results, thus obtained, were statistically analyzed using Pearson's Chi-square test.

Results

A prevalence of 3.96% (91/2300) for MIH was reported without any gender predilection. Molar hypomineralization showed a prevalence of 1.3% (29/2300) whereas the prevalence for hypomineralization of second primary molars was 1.4% (22/1620). The most common type of defect was type 2 and most of the affected teeth were of grade I. Mandibular molars were more commonly affected compared to the maxillary molars.

Conclusions

A prevalence of 3.96% (91/2300) was observed for MIH. Frequent dental screening camps should be organized in schools at the community level for the enhancement of early diagnosis of MIH and designing appropriate management strategies.

How to cite this article

Khan A, Garg N, Mayall SS, et al. Prevalence, Pattern, and Severity of Molar Incisor Hypomineralization in 8-12-year-old Schoolchildren of Moradabad City. Int J Clin Pediatr Dent 2022;15(2):168-174.

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.

Diagnosis training and calibration for epidemiological studies on primary and permanent teeth with hypomineralization

PURPOSE

The objective of this study was to assess the impact on diagnostic accuracy and Kappa values improvement during the three-phase training and calibration process for MIH/HSPM.

METHODS

Thirty dentists were calibrated as examiners for diagnosis of Molar Incisor Hypomineralization (MIH) using Ghanim's index. The whole process was divided into three phases. Phase 1: three meetings with the dentists for the first diagnosis training and calibration (sessions 1a and 1b); phase 2: for a period of 1 month, the dentists started practicing MIH/HSPM diagnosis in the Basic Health Units and an online follow-up group was created to discuss cases and resolve doubts; phase 3: two meetings with the dentists for the second calibration (sessions 2a and 2b). A webpage with educational material was prepared as support during the whole process to improve the dentists' skills in diagnosing MIH/HSPM. The examiners' responses were compared to a gold standard and the Kappa value was obtained.

RESULTS

The average clinical criteria kappa value of the examiners was 0.76 ± 0.19 for the first calibration and 0.93 ± 0.07 (p < 0.05) for the second calibration. For the eruption criteria, the average kappa value was 0.89 ± 0.14 for the first calibration and 0.98 ± 0.08 for the second calibration. Extension criteria had an average kappa value of 0.59 ± 0.15 during the first calibration and 0.75 ± 0.14 during the second calibration.

CONCLUSION

This study demonstrated that the methodology used was an effective tool for improving the diagnostic accuracy of MIH/HSPM.

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life

Molar incisor hypomineralization (MIH) affects the first permanent molars and permanent incisors whose formative embryological process develops around birth and the first year of life. This study’s main objective is to assess the relationship between MIH, on the one hand, with the administration during childbirth of epidural bupivacaine, intramuscular meperidine with haloperidol, synthetic intravenous oxytocin, and prostaglandins such as dinoprostone vaginally, and on the other hand, with suffered pathologies during the first year of life. Cross-sectional retrospective study was carried out on 111 children who attended dental check-ups. Oral examination was carried out to determine MIH involvement. Data on the administration of medications during delivery and the illnesses suffered by the children in the first year of life were taken from the hospital records. Significant relationship with Pearson's chi-square was found between the presence of MIH and the administration of meperidine with haloperidol intramuscularly and the vaginal administration of dinoprostone during labour. Also in children who have suffered serious infections and those who have received antibiotics in early childhood. In recent years there has been a growing trend in many countries to medicalize childbirth even above what the World Health Organization recommends. Some of the drugs used in these protocols could be involved in the appearance of dental mineralization alterations of the MIH type and this would help to explain the increase in its prevalence.

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar: a triple-blind randomized clinical trial

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia.

The use of transillumination in mapping demarcated enamel opacities in anterior teeth: A cross-sectional study

BACKGROUND

Despite intensive efforts for categorizing demarcated enamel opacities, often related to molar incisor hypomineralization (MIH), there is a lack of descriptive criteria aiming to describe them physically outside the scope of color and size. This is most likely due to the indices focusing on molar, not anterior, teeth.

AIM

To map and classify demarcated lesions on permanent anterior teeth using reflected and transilluminated light. The association between classification and related lesion characteristics was also examined.

DESIGN

Permanent anterior teeth with demarcated opacities related to MIH were selected. For each tooth, standardized photographs were taken using transmitted and reflected light. Each lesion was mapped and classified according to its color, lesion size, surface integrity, and type. The data were analyzed using the chi-square and Fisher's exact tests. A logistic regression analysis was performed to identify the risk of PEB.

RESULTS

There were significant relationships between lesion size, color, and type with surface integrity. Lesion type and size were more important than lesion color for assessing the risk of PEB. There was also a significant relationship between lesion size and lesion color.

CONCLUSIONS

Lesion size and type are significant clinical parameters for assessing the risk of PEB on enamel opacities related to MIH.

Prevalence and possible aetiological factors of molar incisor hypomineralisation in Saudi children: A cross-sectional study

Background

A new charting system for molar incisor hypomineralisation (MIH) was recently published and is based on the European Academy of Paediatric Dentistry (EAPD) criteria. This charting system aims to standardise MIH data collection. Therefore, there is a need for new MIH prevalence studies using the currently recommended charting-form.

Aim

To investigate the prevalence and possible aetiological factors of MIH in randomly selected Saudi schoolchildren aged 8–12 years in Riyadh.

Design

A randomly selected sample of Saudi schoolchildren aged 8–12 years attending elementary schools in Riyadh was examined using the EAPD short-form charting, which was recently recommended for the standardised collection of epidemiological data on MIH. To investigate possible aetiological factors of MIH, we collected demographic, pregnancy, and medical history using a questionnaire.

Results

A total of 1,562 children participated in the study (48.8% girls, 51.2% boys). The prevalence of MIH was 15.2%, without a significant difference in the prevalence between the sexes. Among those with MIH, 79.4% had affected incisors and 55.9% had hypomineralised second primary molars. The most prevalent clinical defect was demarcated opacities, and the maxillary arch was more affected. Permanent incisors were more affected in boys than in girls. Defects of the first permanent molars were more severe in terms of clinical status and lesion extent than defects of the permanent incisors. MIH was significantly more prevalent in children with a history of early childhood ear infections, respiratory distress, and tonsillitis.

Conclusions

MIH is common in Saudi schoolchildren living in Riyadh, with no gender predilection. Hypomineralised second primary molars can be used to predict MIH. MIH was significantly associated with childhood illness during the first three years of life, including ear infection, respiratory distress, and tonsillitis.

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.