Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice

Influence of maternal health status during pregnancy and the child´s medical history on molar-incisor hypomineralization in a group of Spanish children (aged 6-14 years): a retrospective case-control study

BACKGROUND

Molar-incisor hypomineralization (MIH) is a qualitative enamel defect that is highly prevalent in children. It has been reported that patients with MIH have higher caries occurrence with an increased need and frequency of dental treatment compared to patients without MIH. The objective of this study was to analyze the association between MIH and a series of factors related to maternal health status during pregnancy and children´s medical history in early childhood.

METHODS

A retrospective study of cases (patients with MIH) and controls (patients without MIH) was designed between 2023 and 2024. A total of 280 children (cases = 140; controls = 140) aged 6 to 14 years (138 boys and 142 girls) were examined according to the European Academy of Pediatric Dentistry (EAPD) criteria for MIH. A survey was carried out with mothers regarding the potential exposure of their children to etiological factors of MIH. Possible prenatal and postnatal etiological factors were obtained through a personal interview with the patients' mothers. The statistical analysis was carried out with the contrast test and the chi-square test.

RESULTS

During pregnancy, folic acid consumption, alcohol intake, systemic viral and/or bacterial infections, and gestational diabetes were statistically significantly related to MIH, as were breastfeeding, asthma, and corticosteroid consumption during childhood.

CONCLUSIONS

Although there are different factors that may have statistically significant relationships with MIH, they cannot be predicted. Therefore, longitudinal studies, with a large sample size, are needed to determine the influence of prenatal and postnatal factors on the prevalence and severity of MIH in children.

Association between molar incisor hypomineralisation and tooth agenesis: a cross-sectional study in Brazilian children and adolescents

PURPOSE

The aim of the present was to assess the association between MIH and tooth agenesis (TA) in orthodontic patients from the Federal University of Rio Grande do Norte, Natal, Brazil.

METHODS

A cross-sectional study was performed to evaluate the presence of MIH and TA in a sample of 371 pretreatment orthodontic records from patients aged 9-18 years. Statistical analyses were performed using the Chi-square and Fisher's exact tests, and logistic regressions.

RESULTS

There was a statistically significant association between the prevalence of tooth agenesis and MIH. A higher percentage of third molar agenesis, maxillary premolar agenesis, and mandibular second premolar agenesis was observed among children with MIH-affected teeth. Patients with MIH had a 2.43 times greater chance of third molar agenesis, and a 5.88 times higher likelihood of mandibular premolar agenesis.

CONCLUSION

There is a weak association between MIH and TA. Furthermore, the presence of hypomineralised molars increases the risk of tooth agenesis.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study

BACKGROUND

Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up.

METHODS

Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient.

RESULTS

There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups.

CONCLUSIONS

Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year.

TRIAL REGISTRATION

The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

The level of dental fear and anxiety is higher in children with both severe Molar-Incisor Hypomineralisation and active dental caries lesions compared to children without these conditions

PURPOSE

To assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions.

METHODS

In this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children's Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%.

RESULTS

The mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0-25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8-13.3; p value = 0.027).

CONCLUSION

Children with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH.

Effectiveness of resin infiltration in the management of anterior teeth affected by molar incisor hypomineralisation (MIH): A systematic review and meta-analysis

OBJECTIVES

To evaluate the effectiveness of resin infiltration in improving the aesthetic appearance of anterior teeth affected by molar-incisor hypomineralisation (MIH).

DATA SOURCES

PubMed, Scopus, EMBASE, Web of Science, ScienceDirect, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2009 to 2024. The protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42023461909).

STUDY SELECTION

Interventional or comparative studies comparing resin infiltration and other treatments in MIH-affected anterior teeth were included. The risk of bias was evaluated using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I tool) and the Risk of Bias 2 (RoB 2.0) tool. Meta-analysis utilized a random-effects model.

DATA

Eighteen studies met the inclusion criteria, and twelve were included in the meta-analysis. Resin infiltration showed a higher color difference (ΔE) before and after treatment (mean difference 2.21, 95 % confidence interval [CI] 0.04-4.38, p < 0.001, I2 = 98.61 %, p < 0.001) and better optical improvement (standardised mean difference [SMD] 2.68; 95 %CI 0.30-5.06; p = 0.027, I2 = 97.8 %, p < 0.001) compared to controls. The estimated success rate based on dentist assessment was 92 % (95 %CI 88-95 %, I2 = 17.92 %, p = 0.06). Non-randomised trials showed high (8/14) or moderate (6/14) risk of bias, mainly from confounding and selection issues. Randomised trials had high risk (1/3) or some concerns (2/3) due to missing data.

CONCLUSIONS

The findings suggest that resin infiltration significantly improves aesthetic outcomes in MIH-affected anterior teeth, as evidenced by higher colour difference and optical improvement compared to controls.

CLINICAL SIGNIFICANCE

While our study shows promising results for resin infiltration, including high success rates and aesthetic improvements, larger-scale studies with longer follow-up periods are necessary to confirm these findings and assess its long-term efficacy.

Prevalence and Association of Caries and Enamel Hypomineralisation/Molar-Incisor Hypomineralisation in 8- to 10-Year-Old Children from Bavaria, Germany

INTRODUCTION

The aim of this cross-sectional epidemiological study was to record caries and enamel hypomineralisation (EH), including molar-incisor hypomineralisation (MIH), and assess associations between both entities in 8- to 10-year-olds from Bavaria, Germany.

METHODS

A total of 5,418 children (mean age 9.8 years; 2,726 females, 2,692 males) were examined using the dmft/DMFT index with additional inclusion of initial or non-cavitated carious lesions (it/IT). EHs were recorded in the primary (eh) and permanent dentition (EH), and individuals with different EH phenotypes were determined as follows: at least one EH, at least one hypomineralised second primary molar (HSPM), at least one hypomineralised first permanent molar (MIH), and at least one hypomineralised first permanent molar and incisor (M+IH). Multiple logistic regression models were constructed to assess association between caries and EH.

RESULTS

The percentage of children without caries in the permanent dentition (DMF = 0) was 88.9%. When data regarding initial carious lesions were included (IDMF = 0), the prevalence decreased to 75.7%. The caries experience was idmf/t = 1.6 and the IDMF/T = 0.6. The mean number of carious teeth in subjects with no eh/EH was higher than that in subjects with HSPM, MIH, or M+IH. The presence of HSPM, MIH, and M+IH was associated with a significantly lower probability of caries in the permanent dentition; the corresponding adjusted odds ratios were 0.55 (95% CI: 0.41-0.75), 0.67 (95% CI: 0.56-0.81), and 0.54 (95% CI: 0.41-0.72), respectively.

CONCLUSIONS

Caries and EH are prevalent conditions in 8- to 10-year-old Bavarian schoolchildren; both dental diseases were negatively associated with each other.

Association of Molar Incisor Hypomineralization with Hypomineralized Second Primary Molars: An Updated Systematic Review with a Meta-Analysis and Trial Sequential Analysis

INTRODUCTION

There is a correlation between molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM), but this relationship has not been definitively confirmed. The purpose of this systematic review and meta-analysis was to reevaluate whether children with HSPM are more affected by MIH than non-HSPM children.

METHODS

A systematic search was conducted in four databases (PubMed, Embase, Web of Science, and the Cochrane Library) for literature, published up to December 2022. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The risk-of-bias assessment of all included cohort studies and case-control studies was assessed by the Newcastle-Ottawa Scale (NOS), and cross-sectional studies were assessed using the Agency for Healthcare Research Quality (AHRQ) scale. RevMan 5.4 software was used for all data analyses, with odds ratios (ORs) and 95% confidence intervals (CIs) as the effect measures. Sensitivity and subgroup analyses were conducted to identify the potential sources of heterogeneity among the studies. Publication bias was tested and corrected by funnel plots and Egger's test. Trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software to control for type-1 and type-2 errors.

RESULTS

A total of 12 studies involving 8,944 children were included in this meta-analysis. Compared with the non-HSPM group, the HSPM group had an increased likelihood of MIH (OR = 10.90, 95% CI = 4.59-25.89, p < 0.05). All the included studies were of moderate-to-high quality. TSA and sensitivity analyses suggested the robustness of this outcome.

CONCLUSION

This systematic review demonstrated a certain correlation between HSPM and MIH, suggesting that HSPM can play a predictive role in the occurrence of MIH. Further high-quality, multicenter, and large-sample longitudinal studies are highly recommended.

Awareness of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPMs) among Northern Italian Dentists: A Questionnaire Survey

BACKGROUND

The purpose of this study was to assess the awareness of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPMs) among dental practitioners in Northern Italy, and to gather data on the occurrence of these conditions in their paediatric patients.

METHODS

A cross-sectional study was conducted using a structured online questionnaire administered through Google Forms. The survey comprised 10 single-choice questions addressing the occurrence of MIH and HSPM in caries-free patients aged 6-9 years.

RESULTS

A total of 315 dentists participated in the survey, yielding a response rate of 31.5%. The majority of respondents reported that 1-25% of their paediatric patients exhibited HSPMs. Among this group, 43.62% of respondents observed MIH in 1-25% of cases.

CONCLUSION

The findings from this survey suggest a consistent perception of MIH and HSPMs among dental practitioners, aligning with known prevalence data and indicating recognition of these conditions within the dental community in Northern Italy.

Proteomic profiling of human dental enamel affected by molar incisor hypomineralisation of different clinical severity grades: an in vitro study

PURPOSE

The aim of this study was to explore the potential to profile and distinguish varying clinical severity grades of MIH, compared to normal enamel, using proteomics.

METHODS

Liquid chromatography-mass spectrometry analyses were conducted on enamel samples of extracted teeth, from 11 children and adolescents, spanning an age range of 6-18 years. Enamel powder samples were collected from extracted, third molars (n = 3) and first permanent molars diagnosed with MIH (n = 8). The MIH tooth samples were categorized into subgroups based on clinical severity grade. The data were statistically analyzed using ANOVA and Welch's t test.

RESULTS

Teeth affected by MIH exhibited a diverse array of proteins, each with different functions related to dental enamel, distinguishing them from their normal enamel counterparts. The application of microdissection combined with LC-MS techniques has revealed the potential to discern unique proteomic profiles among MIH-affected teeth, characterized by varying clinical severity grades. Both analyzed MIH groups displayed consistent trends in the presentation of biological processes, including underabundance of proteins primarily associated with cell organization and biogenesis. Furthermore, proteins linked to cell death were overabundant in both MIH groups.

CONCLUSION

Proteomics enabled the detection and differentiation of various proteins across different clinical severity grades of MIH.

Association between molar-incisor hypomineralisation and dental anomalies

BACKGROUND

Common etiological factors have been reported in the development of molar-incisor hypomineralisation (MIH) and dental anomalies (DA).

AIM

To assess the association between MIH and DAs.

DESIGN

A cross-sectional study was performed to evaluate the presence of MIH and other six DAs in a sample of 415 pretreatment records from patients aged 9-18 years. Statistical analyses were performed using the chi-squared and Fisher's exact tests, and logistic regressions.

RESULTS

There was statistically significant association between the prevalence of DAs and MIH (CI: 1.43-2.43, φ-coefficient: 0.204, PR: 1.87). Higher percentage of tooth agenesis (CI: 1.37-1.68, φ-coefficient: 0.271, PR: 1.50), maxillary premolar agenesis (CI: 1.70-3.65, φ-coefficient: 0.125, PR: 2.49), mandibular second premolar agenesis (CI: 1.68-3.16, φ-coefficient: 0.172, PR: 2.30) and distoangulation of the mandibular second premolars (CI: 1.31-3.47, φ-coefficient: 0.103, PR: 2.13) was observed among children who had MIH-affected teeth. Individuals with MIH had a 2.95 times greater chance of having DAs (R2 = .153). The number of patients with DAs was higher when the first molar showed severe defects (OR = 4.47; R2 = .149).

CONCLUSION

There is a weak association between MIH and DAs. Patients with severe MIH lesions have a slightly higher risk of presenting DAs.

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries

OBJECTIVE

Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion.

METHODS

A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars.

RESULTS

When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167).

CONCLUSION

Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries.

CLINICAL RELEVANCE

The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis

OBJECTIVES

To determine the prevalence of dentin hypersensitivity (DH) and toothache in patients with Molar-Incisor Hypomineralization (MIH); and evaluate whether patients with MIH have greater likelihood of presenting DH/toothache than controls.

DATA

Studies evaluating DH/toothache in patients with MIH were included. Studies focusing on other enamel defects were excluded.

SOURCES

Eight databases, including grey literature, were searched in January 2024.

STUDY SELECTION

The methodological quality of studies was assessed using the Joanna Briggs Institute checklist for Cross-sectional studies. Proportion and association meta-analyses, subgrouped by diagnostic methods, were conducted. The certainty of evidence was assessed using GRADE approach.

RESULTS

Fifteen studies were included in the qualitative analysis and fourteen in the meta-analyses. Two studies fulfilled all items of the methodological quality checklist. The overall prevalence of DH/toothache among patients with MIH was 45 %. Prevalence rates of 30 %, 47 %, and 55 % were estimated based on proxy reports, self-reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22 %, ranging from 16 % to 29 % according to the diagnostic method. Patients with MIH demonstrated higher likelihood of presenting proxy reports of DH/toothache compared to those without MIH (OR: 1.51, 95 % CI [1.23-1.85], P < 0.01, I2: 0 %). The certainty of evidence was very low, mainly due to the low methodological quality of included studies and high inconsistency.

CONCLUSIONS

The global prevalence of DH/toothache was 22 %, per tooth, and 45 % per patient. Estimates vary according to diagnostic methods. Patients with MIH showed higher likelihood of presenting proxy reports of DH/toothache than controls.

CLINICAL SIGNIFICANCE

This systematic review contributes valuable information to the dental literature by assessing the prevalence and associated factors of DH/toothache in patients with MIH. The findings can guide future research, inform clinical practices and public policy makers, and ultimately improve the management of oral health of patients with MIH.

REGISTRATION

PROSPERO CRD42023432805.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

Background

This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children.

Methods

A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed.

Results

The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period.

Conclusions

In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health.

Trial registration

ISRCTN54243749 (13/01/2022).

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial

BACKGROUND

This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children.

METHODS

A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed.

RESULTS

The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period.

CONCLUSIONS

In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health.

TRIAL REGISTRATION

ISRCTN54243749 (13/01/2022).

Association between molar hypomineralization, genes involved in enamel development, and medication in early childhood: A preliminary study

BACKGROUND

Molar hypomineralization (MH) is defined as a multifactorial condition, and thus, its presence may be defined by interactions between environmental and genetic factors.

AIM

To evaluate the association between MH, genes involved in enamel development, and the use of medication during pregnancy in early childhood.

DESIGN

One hundred and eighteen children, 54 with and 64 without MH, were studied. The data collected included demographics, socioeconomic data, and the medical history of mothers and children. Genomic DNA was collected from saliva. Genetic polymorphisms in ameloblastin (AMBN; rs4694075), enamelin (ENAM; rs3796704, rs7664896), and kallikrein (KLK4; rs2235091) were evaluated. These genes were analyzed by real-time polymerase chain reaction using TaqMan chemistry. The software PLINK was used to compare allele and genotype distributions of the groups and to assess the interaction between environmental variables and genotypes (p < .05).

RESULTS

The variant allele KLK4 rs2235091 was associated with MH in some children (odds ratio [OR]: 3.75; 95% confidence interval [CI] = 1.65-7.81; p = .001). Taking medications in the first 4 years of life was also associated with MH (OR: 2.94; 95% CI = 1.02-6.04; p = .041) and specifically in association with polymorphisms in ENAM, AMBN, and KLK4 (p < .05). The use of medications during pregnancy was not associated with MH (OR: 1.37; 95% CI = 0.593-3.18; p = .458).

CONCLUSION

The results of this study suggest that taking medication in the postnatal period appears to contribute to the etiology of MH in some evaluated children. There may be a possible genetic influence of polymorphisms in the KLK4 gene with this condition.

Pericervical Dentin Metrics in Mandibular First Molars Determined with Digital Periapical Radiography and Cone-beam Computed Tomography

INTRODUCTION

Pericervical root dentin is decisive for the long-term mechanical integrity of root-filled teeth. Current treatment protocol does not include a customized step to determine the pretreatment residual pericervical root dentin.

OBJECTIVE

To determine and compare the residual root dentin and canal width using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT) at the apical limit of the pericervical area (PCA) in mandibular first molars.

METHODS

DPR and CBCT images of 60 patients with age between 22 and 76 years were used to determine (a) the mesiodistal widths of the root canal (pericervical dimensions [PCL]-C) and the root (PCL-R) of mandibular first molars at the apical limit of the PCA and (b) the intracanal distance from the apical limit of the PCA to the radiographic apex (intracanal distance [ICD]). The correlation between the PCL and ICD measurements obtained from DPR and CBCT were evaluated.

RESULTS

Values between 0.10-0.80 mm and 0.00-1.10 mm were obtained for PCL-C using DPR and CBCT respectively (95% CI). The PCL values between 0.90-2.30 mm and 0.00-2.30 mm were obtained from DPR and CBCT respectively (95% CI). The ICD ranged between 4.6-12.3 mm in DPR and 4.40-12.0 mm in CBCT (95% CI). The comparative analysis showed differences from -0.9 to 0.5 mms for PCL and -2.00 to 1.5 mms for ICD between DPR and CBCT techniques respectively.

CONCLUSION

The PCL and ICD determined from DPR and CBCT provided the pericervical dentin metrics that could be utilized clinically as a guideline for decision-making in endodontic treatment.

Knowledge and management of molar-incisor hypomineralisation amongst dentists in The Netherlands

BACKGROUND

Molar-incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes.

AIM

To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands.

DESIGN

The study was conducted as a cross-sectional web survey. The questionnaire used included questions regarding respondent characteristics, awareness, knowledge and management of MIH and was distributed through the Royal Dutch Association for Dentistry (KNMT) to a random sample of 900 dentists. Variables were analysed using descriptive statistics, and differences between distinct groups of dentists were tested using the chi-squared test.

RESULTS

Respondents consisted of 76.6% general dental practitioners, 9.1% paediatric dentists and 14.3% differentiated (specialist) dentists, with a 25.6% overall response rate. The majority knew the term MIH and its clinical characteristics, and could distinguish MIH from other enamel defects. Regarding aetiological factors, 76.6% reported a genetic component. In an asymptomatic case, 47.3% reported non-invasive treatments. In a mild symptomatic case, treatments from non-invasive to invasive were reported (p < .05). In a severe symptomatic case, the majority reported invasive treatments. Two-thirds of respondents were interested in further clinical training about MIH.

CONCLUSIONS

Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH.

Potential Association of Molar-Incisor Hypomineralization (MIH) with Dental Agenesis and Infraoccluded Deciduous Molars: Is MIH Related to Dental Anomaly Pattern (DAP)? An Observational Cross-Sectional Study

Background: Dental Anomaly Pattern (DAP) is a collection of morphologic, numeric, and eruptive anomalies of teeth that are often observed together, suggesting a potential genetic relationship. Our objective was to assess the potential associations of Molar-Incisor Hypomineralization (MIH), a common developmental defect of enamel mineralization with a controversial etiology, with two specific components of DAP: (1) agenesis (AG) and (2) infraoccluded deciduous molars (IODM). Establishing such an association between MIH and one or both anomalies would provide evidence supporting a genetic link between MIH and DAP. Methods: We examined pretreatment intraoral standardized photographies and panoramic radiographs from 574 children aged 8-14 years, 287 having MIH and 287 without MIH, comparing the frequencies of AG and IODM in both groups. The subject samples were sourced from the databases of the orthodontic department at a university hospital. Results: The frequencies of AG in the MIH and non-MIH groups were 7% and 8%, respectively (p = 0.751). The corresponding frequencies of IODM were 27% and 19.2%, respectively (p = 0.082). That is, children with MIH did not exhibit an increased frequency of AG or IODM compared to those without MIH. Conclusions: These findings do not support the inclusion of MIH in DAP. Nevertheless, further analysis of possible associations is necessary to definitively validate or invalidate this hypothesis.

Enamel Hypomineralization: Prevalence, Defect Characteristics in Primary Dentition in a Northern Indian Region

Background

No data is available on hypomineralization in the full complement of primary dentition.

Aim

To report on the prevalence and clinical presentation of enamel hypomineralization (EH) in the primary dentition.

Design

A cross-sectional observational study with a random sample of 948, 4-6-year-old schoolchildren of Gautam Buddh Nagar, Uttar Pradesh, India, was conducted after approval from the Institutional Ethics Committee. European Academy of Paediatric Dentistry (EAPD) (2003) criteria were employed to score EH in all primary teeth. A single experienced examiner conducted an entire clinical examination of the study population. Data were expressed as the prevalence, type, extent, and distribution. Further analyses were conducted to compare the prevalence and distribution of different types of lesions in affected subjects using student t-tests and analysis of variance (ANOVA).

Results

An overall prevalence of 7.51% (71/948) was reported. A total of 2.75 ± 1.735 teeth/subject were reported to be affected. The most common lesion was creamy white opacity (p = 0.002), while posteruptive breakdown (PEB) was observed in 40.85% (29/71) of affected subjects.

Conclusion

The prevalence of EH in primary dentition was 7.51%. Further studies mapping the prevalence as well as possible links with molar incisor hypomineralization (MIH) in other geographical locations of the world are required.

How to cite this article

Mittal N, Gupta N, Goyal A. Enamel Hypomineralization: Prevalence, Defect Characteristics in Primary Dentition in a Northern Indian Region. Int J Clin Pediatr Dent 2024;17(S-1):S67-S72.

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.

Molar-Incisor Hypomineralisation: Severity, caries and hypersensitivity

OBJECTIVES

To investigate distribution of affected teeth and severity of molar-incisor hypomineralisation (MIH) in 8-9-year-old children. A second aim was to study association between severity of MIH and hypersensitivity, caries, and affection of incisors and second primary molars (SPM).

METHODS

A total of 3013 children in one age cohort participated in a cross-sectional study, of which 851 children were diagnosed with MIH. A majority of these children were re-examined and MIH diagnosis based on the European Academy of Paediatric Dentistry criteria was confirmed in 538 children. The re-examinations were undertaken at the local clinics by one calibrated dentist. Data were tested with bivariate logistic regression analysis. Results were reported using frequencies, proportions, odds ratios (OR) and confidence intervals (CI).

RESULTS

Almost half of the children with MIH (46.8 %) had at least one severely affected molar. Incisors were affected in 51.9 % of children with MIH, and the prevalence was higher in children with severe affection (57.4 %, p < 0.01). Among children with MIH, second primary molars were affected in 29.6 %, hypersensitivity in at least one first permanent molar was reported by 25.8 and 30.8 % had caries extending to dentine. Children classified with severe MIH were more likely to suffer from hypersensitivity (OR 5.62, 95 % CI 3.61-8.74) and dentine caries (OR 10.32, 95 % CI 6.46-16.50) than children with mild MIH.

CONCLUSION

Prevalence of hypomineralised incisors and SPM were high in the studied children with MIH. Children with severe MIH had higher probability of incisor affection, dentin caries and hypersensitivity.

CLINICAL SIGNIFICANCE

This study highlights the importance of understanding the association between MIH, caries and hypersensitivity, especially in children with severe MIH. These children need extensive and individualized care in the dental services to prevent caries and pain.

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.

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.

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.

Short-term Results of the Masking Effect of an Infiltrant Resin on Mild Molar Incisor Hypomineralization Lesions in Anterior Teeth

This non-controlled clinical study evaluated the masking effect of an infiltrant resin on mild molar incisor hypomineralization (MIH) lesions. Thirty MIH-affected anterior teeth with creamy/ white opacities from 12 children aged 6-15 years received the application of an infiltrant resin (Icon- DMG). Standard photographs were taken before (T1), immediately after (T2), and 1 week after (T3) resin infiltration. Two calibrated examiners qualitatively analyzed the color match using the Fédération Dentaire Internationale (FDI) scale. The binomial distribution test analyzed the scores of the color match at T1 with T2 and T3, and McNemar's test analyzed the scores of the color match between T2 and T3 (α=0.05). There was a significant increase in color match between T1 and T2 (p=0.0005), between T1 and T3 (p=0.0005), and between T2 and T3 (p=0.0019). It was concluded that infiltrant resin was effective in improving the esthetic appearance of creamy/white opacities on MIH-affected anterior teeth.

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.

Update of the molar incisor hypomineralization: Würzburg concept

PURPOSE

Molar incisor hypomineralization (MIH) is playing an increasingly important role in dental practice. MIH is defined as hypomineralization of systemic origin of one to four permanent first molars, often associated with affected incisors. Affected teeth are more susceptible to caries and post-eruptive enamel loss and should be diagnosed and treated as early as possible. In 2016, the Würzburg concept was developed for German-speaking countries including a classification index-the MIH Treatment Need Index (MIH-TNI)-and a treatment plan based on it for the use in daily practice. In the meantime, the concept has also gained international recognition. The aim of this paper is to update part 2 of the Würzburg concept, the treatment plan, as knowledge about MIH has increased and the disease has been studied more extensively in the last years. Other treatment approaches are now available and therefore need to be included in the concept. Although, the evidence of the different treatment options is still weak, practitioners need guidance in their daily practice.

METHODS

The authors reviewed the available literature, including clinical and laboratory studies and published guidelines.

RESULTS

The updated version of the Würzburg concept includes additional non-invasive strategies and temporary therapy options, as well as treatment approaches for incisors. It therefore covers currently available treatment modalities for MIH-affected teeth, ranging from prophylaxis, non-invasive treatment to restorative approaches and possibly even extraction.

CONCLUSIONS

This is intended to help guide the practitioner and will need to be further validated by clinical trials.

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.

Comparative study of articaine 4% versus lidocaine 2% in the local anesthesia of permanent mandibular first molars affected by MIH: a randomized controlled trial

PURPOSE

The current study compares articaine 4% with lidocaine 2% in terms of injection pain and effectiveness of anesthesia when treating permanent mandibular first molars (PMFMs) affected by molar incisor hypomineralization (MIH). In addition to comparing the complications of local anesthesia for both solutions.

METHODS

The sample included 20 children. Each child was randomly assigned to either articaine 4% or lidocaine 2% in their first session with the other solution being used at the subsequent session. Injection pain and the effectiveness of anesthesia were assessed using the Wong-Baker Faces® Pain Rating Scale and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Parents were asked to report any complications of local anesthesia. The Wilcoxon-matched pairs signed-rank test was used to analyze the data.

RESULTS

Patients experienced greater pain when receiving articaine 4% injections according to both scales, differences were statistically significant when using the Wong-Baker Faces® Pain Rating scale (p < 0.05). Whereas, the FLACC scale did not show such differences (P > 0.05). Although there were no significant differences between the two solutions regarding the effectiveness of local anesthesia according to both scales (P > 0.05), articaine 4% was clinically found to be more effective than lidocaine 2%. No complications of local anesthesia were reported.

CONCLUSIONS

Articaine 4% injection was more painful than lidocaine 2%. However, both solutions were effective in anesthetizing PMFMs affected by MIH and without anesthetic complications in the studied sample.

TRIAL REGISTRATION

Clinical trial, NCT05200884, ( https://clinicaltrials.gov/ct2/show/NCT05200884 ).

Real-World Evidence on the Prevalence of Molar Incisor Hypomineralization in School Children from Bucharest, Romania

Molar incisor hypomineralization (MIH) is an understudied and underrecognized clinical entity occurring in children. We performed a cross-sectional study to determine the real-world prevalence of MIH among school children undergoing routine dental checkups at one primary and middle school in Bucharest, Romania. Our study cohort consisted of 266 children with evaluable data, of which 143 (53.8%) were males, with a median age of 10 years old (interquartile range: 8-11 years). In this study cohort, we have identified a prevalence of 14.3% (n = 38 cases) of MIH. Among patients diagnosed with MIH, hypomineralizations were present in 47.4% of children on the maxillary first molar, 92.1% on the mandibular first molar, 94.7% on the maxillary incisor, 36.8% on the mandibular incisor, and 5.3% on the deciduous second molar. We identified the maxillary incisor and the mandibular first molar as the most important examined sites significantly associated with the presence of MIH (p < 0.0001 each), highlighting the importance of paying focused attention to these sites during routine dental care in children. In order to establish the diagnosis of MIH, findings of hypomineralization should be present on at least one permanent first molar, according to the case definition currently in use; this definition does not include findings on the incisors. Thus, our finding that hypomineralization of the maxillary incisors is significantly associated with MIH is particularly important. While incisor hypomineralization is not diagnostic of MIH, based on our results, we conclude that it should raise the suspicion of MIH and lead to an attentive examination of the permanent molars in order to establish timely diagnosis.

Insights into molar-incisor hypomineralisation in past populations: A call to anthropologists

OBJECTIVE

Molar incisor hypomineralisation (MIH) is a developmental defect of enamel affecting the first permanent molars and often the incisors and affecting approximately 13% of the current population worldwide. Here, we aim to highlight potential differential diagnoses of MIH in archaeological collections (taphonomic discoloration, amelogenesis imperfecta, fluorosis, rachitic teeth, etc.).

METHODS

Causative factors of dental discolourations are identified through a literature review.

RESULTS

In an archaeological context, the sediments contained in the burial soil can lead to tooth discoloration. Taphonomic staining of the dentition may have a similar appearance to enamel hypomineralisation, and thus is a confounding factor that has the potential to cause miscalculation of the true prevalence of MIH within archaeological collections. Some rare medieval cases are reported in the modern literature but without microanalysis, misdiagnosis is possible. The aetiological factors of MIH are unknown but probably follow the multifactorial model involving systemic medical and genetic factors.

CONCLUSIONS

Systematic detection and diagnosis of MIH during anthropological studies is therefore of great interest.

SIGNIFICANCE

The hypotheses that only contemporary agents are causative factors of MIH could be refuted by the discovery of individuals living before medication or pollutants. The identification of MIH in a group of individuals also provides information regarding the health status of a population and reflects stress occurring during the period of mineralisation of the first permanent molars after secretion of the enamel matrix.

LIMITATIONS

Taphonomic alterations of archaeological remains prevent MIH diagnosis.

SUGGESTIONS FOR FUTURE RESEARCH

MIH diagnosis can be difficult in archaeological series and further non-destructive methods (microtomography, elemental analyses, etc.) are required.

Predictive Value of Hypomineralization of Second Primary Molars for Molar Incisor Hypomineralization and Other Relationships between Both Developmental Defects of Dental Enamel

Molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM) are dental enamel developmental defects with significant prevalence and psychophysical impact, posing a public health concern. We examined the relationship between HSPM and MIH in 426 children aged 7 to 10 years (213 with MIH, 213 without MIH). The frequency of HSPM was higher in children with MIH (37.1% vs. 11.3%, p < 0.001). However, there was no correlation between MIH severity and presence of HSPM (p = 0.296). In patients with both defects (n = 79), 90% of severe MIH cases were associated with severe HSPM, while 87.8% of mild MIH cases were associated with mild HSPM (p < 0.001). The involvement of permanent incisors by MIH was not influenced by the presence of HSPM or HSPM severity. HSPM exhibited a positive predictive value of 76.7, negative predictive value of 58.8, sensitivity of 37.1% (95% CI = 30.6-43.6%), and specificity of 88.7% (95% CI = 84.5-93%). The odds ratio for MIH based on HSPM was 4.64 (95% CI). HSPM may serve as a predictor of MIH, but its absence does not rule out the occurrence of MIH. The results highlight the need for surveillance programs in children presenting with HSPM to facilitate early diagnosis and preventive measures for MIH-related complications.

Contemporary Understanding of the Etiology and Management of Molar Incisor Hypomineralization: A Literature Review

Molar incisor hypomineralization (MIH) is a significant health problem that can affect the child's quality of life by negatively affecting their esthetics and function. This review aimed to summarize the etiology and pathogenesis of MIH. It also aimed to summarize the recent studies on MIH in children and adolescents, focusing on diagnosis, prevention, and clinical management. An electronic search on the PubMed, Cochrane Database of Systematic Reviews, MEDLINE, MedlinePlus, WHO reports, and Google Scholar databases was performed. The volume of research on the etiology, presentation, and clinical management of MIH is still expanding. The creation and validation of indices for the diagnosis and management of MIH, as well as any potential genetic aspects appear to be the main areas of current research. Notably, MIH was linked to childhood illnesses, the use of antibiotics, and early childhood fever. Although many studies discuss the different options for managing MIH lesions, evidence-based studies that address the long-term outcomes of MIH are still lacking. Indeed, future clinical studies should be directed to evaluate the impact of each systemic etiological factor and its different types of management on normal amelogenesis. Regarding the diagnosis, future research should focus on the pre-eruption diagnosis and early approaches to prevent the post-eruption breakdown and caries. Regarding the treatment of MIH, future investigations should emphasize further improvements in adhesion and the use of new materials and techniques, such as digital dentistry.

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.

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations.

METHODS

Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics.

CONCLUSION

This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Study on machine learning of molar incisor hypomineralization in an endemic fluorosis region in central China

Objectives: The aim of the present study was to develop a machine learning model to predict the risk of molar incisor hypomineralization (MIH) and to identify factors associated with MIH in an endemic fluorosis region in central China.

Methods: A cross-sectional study was conducted with 1,568 schoolchildren from selected regions. The clinical examination included an investigation of MIH based on the European Academy of Paediatric Dentistry (EAPD) criteria. In this study, supervised machine learning (e.g., logistic regression) and correlation analysis (e.g., Spearman correlation analysis) were used for classification and prediction.

Results: The overall prevalence of MIH was 13.7%. The nomograph showed that non-dental fluorosis (DF) had a considerable influence on the early occurrence of MIH and that this influence became weaker as DF severity increased. We examined the association between MIH and DF and found that DF had a protective correlation with MIH; the protective effect became stronger as DF severity increased. Furthermore, children with defective enamel were more likely to experience caries, and dental caries were positively correlated with MIH (OR = 1.843; 95% CI: 1.260–2.694). However, gender, oral hygiene, and exposure to poor-quality shallow underground water did not increase the likelihood of developing MIH.

Conclusions: DF should be considered a protective factor within the multifactorial etiology of MIH.

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.

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.

Oral manifestation in a pediatric patient with pentasomy x. A case report

Aim

To describe the oral finding, physical features and medical features with the genetic diagnosis of a Pentasomy X.

Case report

A 6-year-old female patient was referred for oral evaluation presenting acute pain related to ulcers in the attached gingival and dorsum of tongue mucosa. Medical history revealed Pentasomy X associated with interatrial communication, convergent strabismus, recurrent seizures, dysautonomia, episodes of thrombosis and cognitive delay with limited oral communication skills. A palliative oral treatment was applied. Oral hygiene improvement and surveillance were decided considering the absence of dental hypersensitivity, post eruptive enamel breakdowns or dental caries. Less than 30 cases had been reported in the literature, reflecting the rare nature of this genetic disorder and with great difficulties to perform dental treatment. As regards the oral health status of these patients, with an emphasis on dental care, information is totally lacking.

Conclusion

Oral care in patients with genetic syndromes must consider the status in general health to prevent medical complications associated with oral disease or dental treatment. Minimal intervention and surveillance are appropriate options in customized therapy.

Prevalence of and factors associated with molar-incisor hypomineralisation in schoolchildren in the canton of Basel-Landschaft, Switzerland

OBJECTIVES

As prevalence of molar-incisor hypomineralisation varies considerably in different countries and regions, the aim of this study was to obtain representative epidemiological data for schoolchildren living in the canton of Basel-Landschaft, Switzerland.

MATERIAL AND METHODS

A representative population of schoolchildren of three different age groups, i.e. 1st grade (mean age: 7.4 years), 6th grade (mean age: 12.6 years), and 9th grade (mean age: 15.7 years) visiting compulsory schools in the canton of Basel-Landschaft, Switzerland, was examined. The presence or absence of molar-incisor hypomineralisation at time of examination was recorded as well as potential influencing factors such as age group, gender, nationality, or the children's place of residence.

RESULTS

A total of 1252 schoolchildren could be included. On average, the prevalence of MIH in the study population was 14.8%. No statistically significant differences were found for nationality, gender, or place of residence. Although not statistically significant, children from the youngest age group had the highest while children from the oldest age group had the lowest MIH prevalence.

CONCLUSION

With a mean value of 14.8%, MIH prevalence among schoolchildren living in the canton of Basel-Landschaft, Switzerland, is comparable to mean values recorded globally.

CLINICAL RELEVANCE

This study represents the first study on MIH prevalence in Switzerland and also provides further evidence on potential influencing factors.

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.

Knowledge, perceptions, attitudes, and clinical experiences on molar incisor hypomineralization among Syrian pediatric dentists and general dental practitioners: a cross-sectional study

BACKGROUND

Molar incisor hypomineralization (MIH) is a widespread oral health problem. Dentists encounter several challenges regarding MIH management worldwide. The aim of this study was to evaluate and compare the knowledge, perceptions, attitudes, and clinical experiences on MIH among general dental practitioners and pediatric dentists in Syria.

METHODS

All general dental practitioners and pediatric dentists belonging to the Syrian Dental Syndicate of Damascus were invited to complete a cross-sectional structured questionnaire (n = 1936). The questionnaire consisted of four sections and required responses regarding demographic data, knowledge, perceptions, attitudes, and experiences on MIH. Data were analyzed with Pearson's chi-square test and multivariate regression models using SPSS Ver. 23.0.

RESULTS

The overall response rate was 36.31% (703/1936). Pediatric dentists were significantly more familiar with MIH (p < 0.001) and more confident when diagnosing it (p < 0.001). Most participants (43.95%) perceived an increase in MIH prevalence in Syria. Stainless steel crowns were the most favorable restorative material for molars with post-eruptive breakdown (51.38%). As for molars and incisors with opacities, composite resin was preferred with (41.82%), and (67.51%) respectively. General dental practitioners requested further training regarding MIH treatment (p < 0.001).

CONCLUSIONS

Pediatric dentists were equipped with further knowledge regarding MIH, and were more confident when diagnosing it. There is a need for additional training and education for general dental practitioners. Most respondents perceived an increase in the prevalence of MIH. There is a dearth of data regarding MIH prevalence in Syria. The materials of choice for restoring teeth with MIH were stainless steel crowns and composite resin.

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.

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.