Molar incisor hypomineralisation (MIH) - an overview

The history of treatment planning the extraction of the first permanent molar in the UK

This paper researches the history of treatment planning for extraction of the first permanent molars and the early influence of American orthodontists on dental practice in the UK. It also discusses the development of clinical guidelines for the enforced extraction of first permanent molars to the present day.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study

OBJECTIVES

This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal.

METHODS

The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups.

RESULTS

During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002).

CONCLUSION

Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization.

CLINICAL SIGNIFICANCE

SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Knowledge and perception regarding molar incisor hypomineralisation among dental students and dental hygienist students in Spain: a cross-sectional study

BACKGROUND

Molar incisor hypomineralisation (MIH) has a high prevalence in the Spanish pediatric population and is a precursor of carious lesions in teeth in which it is present. Although this pathology is included in the curricula of the Degree in Dentistry and the Training Cycle in Oral Hygiene in our country, the contents currently taught seem to be insufficient in relation to the level of knowledge that we have today about this condition.

METHODS

A digital questionnaire of 18 questions was sent to a sample of 448 students attending the 4th and 5th year of the Degree in Dentistry and 2nd year of the Training Cycle in Oral Hygiene from different universities and vocational training centers in the Valencian Community. Descriptive and multivariate statistical analysis of the data was subsequently performed.

RESULTS

Of the 290 questionnaires that were obtained, 53.8% were from students attending the 2nd year of a training course in oral hygiene and 46.2% were from students pursuing a degree in dentistry. Most of the respondents had heard about MIH (75.2%), mainly through master classes. However, most students had difficulties distinguishing MIH lesions from other lesions (58.3%). The degree of knowledge about MIH was greater among dental students in all the aspects evaluated: prevalence, diagnosis, prevention, and treatment. Of all the students, 83.8% were interested in increasing their training on MIH, especially in the areas of diagnosis and treatment.

CONCLUSION

The results of the present study justify the need to expand the content on MIH, both theoretical and practical, in the educational curricula of the Degree in Dentistry and Integrated Vocational Training Centers in Spain.

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).

Management of permanent incisors affected by Molar-Incisor-Hypomineralisation (MIH) using resin infiltration: a pilot study

PURPOSE

To compare the aesthetic improvement of Molar-Incisor-Hypomineralisation (MIH) opacities treated by applying Icon-Etch for three cycles with the opacities treated by Icon-Etch for once, in the course of resin infiltration technique.

METHODS

Thirty incisors were sorted based on the colour of the opacities and then distributed according to the number of Icon-Etch cycles using a randomisation table into the groups: (1) White/Creamy one cycle, (2) White/Creamy three cycles, (3) Yellow/Brown one cycle, (4) Yellow/Brown three cycles. The primary outcomes of applying the resin infiltration to the opacities were compared amongst groups according to the parents' satisfaction, the amount of coverage, and the colour matching with the surrounding sound enamel. The stability of the results after 3 months was evaluated using a spectrophotometer.

RESULTS

The colour of the opacity pre-treatment affected the outcomes significantly (p < 0.05), compared according to the method of application (p > 0.05) in terms of parents' satisfaction. Whilst the multiple applications for Icon-Etch cycles showed more coverage amount in White/Creamy opacities than the application ones (p < 0.05); in colour matching, there was no statistically significant difference between the two methods (p > 0.05). For yellow/brown opacities, some negative results occurred with the single Icon-Etch cycle.

CONCLUSION

In MIH opacities, it is possible to rely on the resin infiltration as a minimally invasive method to achieve acceptable results, especially with multiple Icon-Etch cycles applications in the white/creamy opacities. The colour stability has not been affected by either the colour of the opacity or the number of cycles.

Comparison of aesthetic treatments for molar-incisor hypomineralisation: Systematic review and meta-analysis

Introduction

Molar incisor hypomineralisation (MIH) is a developmental defect that predominantly targets the first permanent molars and incisors and consists of hypomineralisation of the enamel. A range of treatment options are available to improve aesthetics in this condition, including resin infiltration, bleaching techniques, restorations, microabrasion, and laser therapy.

Objectives

This systematic review and meta-analysis aimed to analyse the effects of treatments on changes in enamel colour in teeth with MIH lesions and determine whether resin infiltration is the most aesthetic treatment.

Material and Methods

A systematic literature search was conducted on PubMed, Web of Science, EBSCO, and Scopus databases until December 2022. The addressed PICO question was: "Is resin Infiltration the most effective treatment for restoring aesthetics in comparison to other treatments in patients with Molar incisor hypomineralisation?''. In addition, a meta-analysis was conducted with the selected studies to integrate the information using R.51 software (R Core Team (2013)).

Results

In total, 678 articles were obtained from the initial search, of which 11 met the inclusion criteria. Seven studies concluded that resin infiltration was the most successful treatment method in the aesthetic rehabilitation of MIH lesions. Six of the eleven articles were included in the meta-analysis, which indicated that the treatments generated substantial colour changes.

Conclusions

This systematic review and meta-analysis provided significant data suggesting that resin infiltration is the most effective treatment for achieving aesthetic improvements in MIH lesions, with the meta-analysis providing a significant result (p = 0.051) in favour of the hypothesis.

Molar incisor hypomineralisation: A survey of awareness and management strategies among Libyan dentists in Benghazi

BACKGROUND

Molar incisor hypomineralisation (MIH) is a developmental enamel defect in the first permanent molars and frequently in the incisors. It poses a unique challenge to the dental practitioner because of its nature, clinical presentations and treatment strategies.

AIM

This study assessed the perception of Libyan dentists in Benghazi regarding MIH and its management.

DESIGN

Paper-based, self-administered questionnaires were distributed to dentists in Benghazi, Libya. The questionnaires investigated the awareness of MIH, knowledge of MIH aetiology, clinical challenges of MIH treatment and choices of restorative management. Descriptive statistics, chi-squared test and binary logistic regression analysis were performed at a significance level of ≤.05.

RESULTS

A total of 389 questionnaires were completed and analysed, giving an overall response rate of 76% (389/511). Most participants were female (85%, 332), with an average of 6.05 (SD = 6.24) years of experience. The majority of participants (67%) recognised MIH in their practice. Statistically significant differences in the awareness of MIH and its prevalence were observed according to the type of practice (p ≤ .001) and experience of dentists (p ≤ .001). Dentists working in public dental practice were less familiar with MIH and less likely to report it. Likewise, novice dentists were less aware of MIH than more experienced colleagues. The most reported aetiological factor in MIH was genetics by 60.2% of respondents, followed by environmental contamination (47.6%) and fluorides (42.9%). Most participants (92.3%) considered MIH a clinical problem. Aesthetics and diagnosis were the most reported challenging aspects (59.4% and 44.2%, respectively). The most commonly selected restorative options were high-fluoride glass ionomer cement (43.2%) and preformed metal crowns (41.6%).

CONCLUSION

The majority of participants reported awareness of the existence of MIH condition. Nevertheless, variations in estimating MIH prevalence and its proper treatment, as well as factors influencing its treatment and diagnosis, were recorded. It is recommended that the current dental curriculum is reviewed, and scientific evidence providing dental practitioners with updated information on the diagnosis and clinical management of MIH should be circulated.

Association between psychological factors and molar-incisor hypomineralization: A cross-sectional study

BACKGROUND

Molar-incisor hypomineralization (MIH) is a developmental enamel defect characterized by opacities from white to brownish color. A suspected multifactorial etiology has been suggested, whereas psychological factors during pregnancy have only been limitedly analyzed.

AIM

We assessed the association between stress, depression, and anxiety in pregnancy and the presence of MIH in children at a later age.

DESIGN

Using a cross-sectional Web-based questionnaire, we included 384 mothers who had children aged 6 and 12 years from Pasto, Colombia. Data were collected between October 2021 and March 2022. Sociodemographic variables; maternal and child factors related to prenatal, natal, or postnatal problems; and psychological factors such as stress and symptoms of anxiety and depression in pregnancy were inquired. Utilizing photographs depicting MIH lesions, mothers assessed their child's MIH status. A directed acyclic graph (DAG) analysis was performed to create causal assumptions, and logistic regression models were estimated to evaluate these assumptions. p-value was set at p < .05.

RESULTS

The prevalence of MIH was 33.3%; 12.8% of the participants exhibited hypomineralization in both molars and incisors. DAG analysis and logistic regression models determined that MIH (present or not) was associated with symptoms of maternal depression (ORadj  = 3.26, 95% CI: 1.92-5.52, p < .001), and MIH (both molars and incisors) was associated with symptoms of maternal anxiety (ORadj  = 3.49, 95% CI: 1.80-6.76, p < .001).

CONCLUSION

Psychological factors, among others, were significantly associated with the presence of MIH.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.

Management of Turner's Hypoplasia Using Resin Infiltration: A Case Report

The causes of enamel discoloration can vary, leading to aesthetic concerns for patients. Injuries to primary teeth can lead to developmental issues in permanent successors, with enamel hypoplasia, commonly referred to as Turner's tooth. Diverse methods are available for addressing tooth discoloration. A case of an 11-year-old pediatric patient with a brown patch on the upper left central incisor was reported to the Pediatric Dentistry Department. A well-demarcated, yellowish-brown lesion was present on the labial surface of 21 and was diagnosed as Turner's hypoplasia. Resin infiltration was done using the Icon Smooth Surface (DMG America Company, Englewood, NJ) resin infiltration kit. The resin infiltration technique provides an approach to meet aesthetic requirements. In this case, the resin infiltration technique was successfully utilized to address the discoloration of the left maxillary central incisor, which was affected by Turner's hypoplasia.

Proteomic Analyses Discern the Developmental Inclusion of Albumin in Pig Enamel: A New Model for Human Enamel Hypomineralization

Excess albumin in enamel is a characteristic of the prevalent developmental dental defect known as chalky teeth or molar hypomineralization (MH). This study uses proteomic analyses of pig teeth to discern between developmental origin and post-eruptive contamination and to assess the similarity to hypomineralized human enamel. Here, the objective is to address the urgent need for an animal model to uncover the etiology of MH and to improve treatment. Porcine enamel is chalky and soft at eruption; yet, it hardens quickly to form a hard surface and then resembles human teeth with demarcated enamel opacities. Proteomic analyses of enamel from erupted teeth, serum, and saliva from pigs aged 4 (n = 3) and 8 weeks (n = 2) and human (n = 4) molars with demarcated enamel opacities show alpha-fetoprotein (AFP). AFP expression is limited to pre- and perinatal development and its presence in enamel indicates pre- or perinatal inclusion. In contrast, albumin is expressed after birth, indicating postnatal inclusion into enamel. Peptides were extracted from enamel and analyzed by nano-liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) after tryptic digestion. The mean total protein number was 337 in the enamel of all teeth with 13 different unique tryptic peptides of porcine AFP in all enamel samples but none in saliva samples. Similarities in the composition, micro-hardness, and microstructure underscore the usefulness of the porcine model to uncover the MH etiology, cellular mechanisms of albumin inclusion, and treatment for demarcated opacities.

Aesthetic management of discoloured incisors in children

Children can often present with discolouration of their teeth, commonly affecting their permanent maxillary central incisors. These opacities can often cause children to suffer with psychosocial and confidence related issues. With long waiting lists in secondary care, many children may face increased waiting times to receive aesthetic dental treatment. It is important that the dental professional is aware of the different causes of discolouration, the possible treatment options and when to consider a referral to secondary care.

Passive Smoking and Oral Health of Infants, Preschoolers, and Children: A Systematic Review

INTRODUCTION

Almost half of the world's children experience passive smoking, which is linked to numerous oral health conditions. The aim is to synthesize data on the impact of passive smoking on oral health of infants, preschoolers, and children.

AIMS AND METHODS

A search was conducted across Medline (via EBSCOhost), PubMed, and Scopus up to February 2023. Risk of bias was assessed according to the Newcastle-Ottawa Scale (NOS).

RESULTS

The initial search produced 1221 records and after removal of duplicates, screening by title and abstract, and full-text assessment, 25 studies were eligible for review and data extraction. The majority of studies (94.4%) found a correlation between passive smoking and increased prevalence of dental caries with three studies suggesting a dose-response relationship. Prenatal passive smoking exposure in 81.8% of studies indicated an increased dental caries experience compared to postnatal exposure. Low parental education, socioeconomic status, dietary habits, oral hygiene, and gender affected the level of environmental tobacco smoke (ETS) exposure and dental caries risk.

CONCLUSIONS

The results of this systematic review strongly suggest a significant association between dental caries in the deciduous dentition and passive smoking. Early intervention and education on the effects of passive smoking on infants and children will allow for the improvement in oral health outcomes and reduction in smoking-associated systemic conditions. The results justify all health professionals paying more attention to passive smoking when conducting pediatric patient histories, contributing to improved diagnosis and appropriate treatment planning with more suitable follow-up schedules.

IMPLICATIONS

The evidence from this review that environmental tobacco smoke and passive smoking is a risk factor for oral health conditions, both prenatally and postnatally during early childhood, justifies all health professionals paying more attention to passive smoking when conducting pediatric patient histories. Early intervention and appropriate parental education regarding the effects of secondhand smoke on infants and children will allow for the minimization of dental caries, improvement in oral health outcomes and overall reduction in smoking-associated systemic conditions for the children exposed.

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.

Perfluorooctanoic acid-induced cell death via the dual roles of ROS-MAPK/ERK signaling in ameloblast-lineage cells

Perfluorooctanoic acid (PFOA) is an artificial fluorinated organic compound that has generated increased public attention due to its potential health hazards. Unsafe levels of PFOA exposure can affect reproduction, growth and development. During tooth enamel development (amelogenesis), environmental factors including fluoride can cause enamel hypoplasia. However, the effects of PFOA on ameloblasts and tooth enamel formation remain largely unknown. In the present study we demonstrate several PFOA-mediated cell death pathways (necrosis/necroptosis, and apoptosis) and assess the roles of ROS-MAPK/ERK signaling in PFOA-mediated cell death in mouse ameloblast-lineage cells (ALC). ALC cells were treated with PFOA. Cell proliferation and viability were analyzed by MTT assays and colony formation assays, respectively. PFOA suppressed cell proliferation and viability in a dose dependent manner. PFOA induced both necrosis (PI-positive cells) and apoptosis (cleaved-caspase-3, γH2AX and TUNEL-positive cells). PFOA significantly increased ROS production and up-regulated phosphor-(p)-ERK. Addition of ROS inhibitor N-acetyl cysteine (NAC) suppressed p-ERK and decreased necrosis, and increased cell viability compared to PFOA alone, whereas NAC did not change apoptosis. This suggests that PFOA-mediated necrosis was induced by ROS-MAPK/ERK signaling, but apoptosis was not associated with ROS. Addition of MAPK/ERK inhibitor PD98059 suppressed necrosis and increased cell viability compared to PFOA alone. Intriguingly, PD98059 augmented PFOA-mediated apoptosis. This suggests that p-ERK promoted necrosis but suppressed apoptosis. Addition of the necroptosis inhibitor Necrostatin-1 restored cell viability compared to PFOA alone, while pan-caspase inhibitor Z-VAD did not mitigate PFOA-mediated cell death. These results suggest that 1) PFOA-mediated cell death was mainly caused by necrosis/necroptosis by ROS-MAPK/ERK signaling rather than apoptosis, 2) MAPK/ERK signaling plays the dual roles (promoting necrosis and suppressing apoptosis) under PFOA treatment. This is the initial report to indicate that PFOA could be considered as a possible causative factor for cryptogenic enamel malformation. Further studies are required to elucidate the mechanisms of PFOA-mediated adverse effects on amelogenesis.

Molar-incisor hypomineralisation: Knowledge and perception of Syrian undergraduate and postgraduate dental students

INTRODUCTION

Dentists' knowledge and expertise, especially in their early career, are primarily shaped during undergraduate studies. This cross-sectional study aimed to assess the knowledge and perception of Syrian under- and postgraduate students regarding diagnosing and managing molar-incisor hypomineralisation (MIH)-affected teeth.

MATERIALS AND METHODS

Final-year dental students (FY-students), postgraduates in paediatric dentistry (PD-postgraduates) and postgraduates in other lines of specialty (OS-postgraduates) in all Syrian dental schools were invited to participate in an established web-based survey covering the knowledge and attitudes regarding the prevalence, aetiology, diagnosis and management of MIH. Data were analysed with descriptive statistics and Fisher's exact/chi-squared tests at 5%.

RESULTS

In total, 1142 post- and undergraduate students from six public and five private dental schools in Syria participated in this study (867 FY-students, 74 PD-postgraduates and 201 OS-postgraduates). PD-postgraduates were found to present statistically significantly better knowledge regarding MIH compared with the two other groups. Only 19% of FY-students and 54% of OS-postgraduates reported themselves familiar with MIH (compared with 97% of PD-postgraduates). Similarly, 18% of FY-students and 27% of OS-postgraduates were capable of diagnosing MIH (compared with 81% of PD-postgraduates). Stainless-steel crowns and direct composite fillings were chosen as most suitable for treating MIH-affected molars from all responders.

CONCLUSIONS

FY-students and even OS-postgraduates in Syria lack knowledge and confidence when confronted with MIH. The university curricula need to include more educational materials to equip the students with the necessary tools to manage MIH clinically.

Prevalence and risk factors of molar incisor hypomineralization in the Middle East: A systematic review and meta-analysis

Objectives

Molar incisor hypomineralization (MIH) is a growing global concern. Herein, we conducted a systematic review and meta-analysis of the prevalence and associated factors/risk factors of MIH in the Middle East (ME).

Methods

This systematic review and meta-analysis included studies on children with at least one first permanent molar affected by MIH, aged 5-18 years, without syndromes or congenital anomalies, and residing in the ME and included cross-sectional, case-control, and cohort studies. Keywords related to MIH and ME countries were systematically searched until January 10, 2021 in four databases, PubMed, Google Scholar, Science Direct, and the Cochrane Library, following the specified eligibility criteria. The Joanna Briggs Institute quality assessment tool was used to evaluate all included studies. Meta-analyses were conducted to assess the effect of risk factors. The study protocol was registered on the PROSPERO International Prospective Register of Systematic Reviews (Registration No. 247391).

Results

After screening 4,373 documents, 29 eligible studies with a total of 32,636 children aged 7-12 years were included from 11 countries. The frequency of MIH reported in the ME ranged from 2.3% to 40.7%, with a mean prevalence of 15.05%. Pregnancy and early childhood illnesses (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.91-2.68; P < 0.001) and factors related to delivery (OR: 2.4, 95% CI: 1.55-3.72; P < 0.001) were statically significantly associated with MIH.

Conclusion

The mean prevalence of MIH in ME aligns with the global MIH prevalence rate. Illnesses and delivery complications are risk factors that could be controlled to prevent MIH. As included studies showed high heterogeneity in the meta-analyses, further evidence from the ME is needed to assess the prevalence and other associated environmental risk factors for MIH.

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.

Prevalence of Molar-incisor hypomineralization in Iranian children – A systematic review and narrative synthesis

Introduction

Molar-incisor hypomineralization is a developmental defect of enamel with clinical features vary from demarcated opacities to severe tissue breakdown which calls for considerable preventive and interceptive measures. The aim of this article was to systematically review the literature on the prevalence of MIH in Iran and highlight the condition in Iranian children.

Materials and Methods

A systematic search of literature was conducted in Scopus, Pubmed, Ovid, Embase, Web of Science, and Google-Scholar as well as national Iranian database and digital archives of dental schools from the beginning of 2000 to the end of 2021 for published and unpublished studies. Data from cross-sectional, cohort, and case-control studies on prevalence of molar-incisor hypomineralization among 6–13-year-old children was gathered, using the following MeSH terms and keywords and their Persian equivalents: Prevalence, Hypomineralisation, Hypomineralization, MIH, “molar incisor”, “molar-incisor”, “cheese molars”, “Hypomineralised first permanent molars”, “Hypomineralized first permanent molars”, “developmental defects of enamel”, “enamel developmental defects”, Iran*. Methodological quality and the risk of bias of quantitative studies was assessed using a modified version of Newcastle-Ottawa Scale. Due to the considerable clinical and statistical heterogeneity of the included studies, pooling of data through meta-analysis was not possible. Therefore, a descriptive synthesis of data was performed.

Results

Fifteen cross-sectional studies with a total number of 12011 participants were included in the systematic review. The prevalence of MIH ranged from 5.1% to 25.6%. All of the included studies were at a moderate risk of bias (NOS of 4-6). The lowest prevalence of MIH was reported in Kerman (5.14%) and the highest in Tehran (25.6%). Substantial methodological, clinical and statistical heterogeneity was observed.

Conclusion

This is the first study to systematically review the available literature on MIH prevalence in Iran. However, the present review has some limitations such as limited number of included studies, large heterogeneity of the research, and moderate quality of included studies. Further high-quality research is warranted.

Evaluating the Prevalence and Distribution of Dental Anomalies in the Permanent Dentition of Patients Seeking Dental Care

BACKGROUND

 Disturbances seen during tooth formation result in developmental dental anomalies presenting in the oral cavity. These anomalies manifest as discrepancies in the number, color, size, and shape of the teeth. These dental anomalies can either be acquired, congenital, or developmental. Their early detection and management are necessary as they affect aesthetics and occlusion. The study had the aim of gauging the prevalence of developmental anomalies in the permanent dentition of Indian subjects.

METHODS

A total of 1192 participants recruited from the institute for study purposes, comprising males and females, were examined clinically and radiographically, and their dental casts were also evaluated. These subjects were assessed for anomalies in position, structure, number, and/or shape. Anomalies in the position include transmigration, transportation, and/or ectopic position; anomalies in the structure, including dentinogenesis imperfecta or amelogenesis imperfecta; anomalies in number, including hyperdontia or hypodontia; and anomalies in shape, including peg laterals, taurodontism, fusion, dens evaginatus, talon cusp, and/or microdontia.

RESULTS

A statistically significant difference was seen in unilateral microdontia and dentinogenesis imperfecta between males and females, with attained p-values of 0.003 and 0.06, respectively. The results of the present study showed that 9.89% (n = 118) study subjects, whereas 1% (n = 12) study subjects had two dental anomalies in their permanent dentitions, with no subject presenting more than two dental anomalies, showing that various dental anomalies have a low prevalence in the Indian population.

CONCLUSION

The present study has led to the conclusion that the prevalence of dental anomalies is low in Indian subjects. However, these anomalies should be detected and treated early to prevent them from causing further complications.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence and Possible Etiological Factors of Molar-Incisor Hypomineralization (MIH) in Population of Silesian Children in Poland: A Pilot Retrospective Cohort Study

(1) Background: This pilot retrospective cohort research study regarded the frequency of the prevalence of molar-incisor hypomineralization (MIH) in a population of Silesian children in Poland. The evaluation of the potential environmental etiological factors was performed and the correlation between the environmental factors and MIH was analyzed. (2) Methods: A total of 613 children were randomly enrolled in the pilot study (9.0 years ± 1.9). A survey was carried out with mothers regarding the potential exposure to environmental etiological factors of MIH in their children. The patients’ clinical assessments were carried out in the dental unit. (3) Results: The frequency of prevalence of MIH in the population of Silesian children was established at the level of 6.2% (p < 0.05). MIH symptoms were significantly associated with otitis in early childhood (OR = 2.50), atopic dermatitis (OR = 5.69), and premature delivery before 38 weeks of pregnancy (OR = 2.88). (4) Conclusions: MIH was observed in 6.2% of the population of Silesian children, and there was a relationship between environmental risk factors such as otitis, atopic dermatitis, premature birth, and MIH expression. Therefore, further research is needed to determine the influence of pre-, peri-, postnatal, and prophylactic factors on the frequency and severity of MIH symptoms in children.

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

Aim

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Molar-incisor hypomineralisation combat: exploratory qualitative interviews with general dental practitioners in England regarding the management of children with molar-incisor hypomineralisation

Introduction Molar-incisor hypomineralisation (MIH) presents as a spectrum, with severe cases becoming increasingly complex to manage. This study aimed to investigate the perceptions and experience of general dental practitioners (GDPs) in England when managing children with MIH.Method Semi-structured telephone interviews with GDPs who regularly treat children took place in May 2020. A sample of four male and six female GDPs with 1-15 years of experience was achieved through purposively sampling interested parties following advertisement via professional groups. Thematic analysis using a realist and inductive approach was used in analysis.Results The overarching theme was of managing uncertainty, with four subthemes: setting the scene; fighting the tooth; working within the system; and self and interpersonal insight. Despite being knowledgeable, participants expressed varying levels of confidence in many aspects while managing children with MIH. There was a great deal of uncertainty surrounding 'doing the right thing' across the themes. Systemic barriers to managing children with MIH within the general dental service were identified.Conclusion The challenges of managing children with MIH was experienced as 'uncertainty'. Barriers within the general dental service made managing children with MIH difficult and participants relied on colleagues in secondary care to manage severe cases.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: A cross-over, randomized clinical trial

BACKGROUND: Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. OBJECTIVE: To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). METHODS: As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. RESULTS: The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p < 0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p = 0.970) and yellow/brown (p = 0.948) opacities. CONCLUSIONS: The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

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.

The Six-Year-Old 'Adult'

Children are not miniature adults, yet when a child celebrates their sixth birthday, little do they know that, with the arrival of their first 'adult' tooth, they are about to gain their first real experience of being a 'grown-up'. The age of six is a key milestone in the mental, physical and emotional wellbeing of children, with most children in the UK having commenced primary school education by their fifth birthday. Six-year-olds are about to enter the most critical period in their dental development, the mixed-dentition phase, where their mouths are in a near continuous state of flux. This pivotal age in their dental development should not be undervalued; the dental decisions we make at this age means childhood lasts a lifetime. Caries is the most prevalent, preventable global disease, and with one in four children suffering from dental caries in the primary dentition by the time they start school, the foundations we lay down at the age of six translate into lifelong benefits for the permanent dentition. In this paper, the aim is to demonstrate that at the age of six we get a second chance to get things right. From caries risk factors and tailoring the five pillars of prevention by educating parents on the developing dentition, to reinforcing the importance of habit-breaking, developmental anomalies of enamel and early orthodontic intervention, this paper describes the importance of the age of six, never before so exclusively expressed in a dental sense.

The impact of COVID-19 on paediatric dental services and tips for patient management

Managing paediatric patients in primary dental care while awaiting treatment by the specialist paediatric dental services can be tricky. COVID-19 has had a significant impact on dental services meaning wait times to be seen by a paediatric dental service may have been delayed. This article will discuss the management of paediatric patients in primary dental care and provide an update on some of the latest techniques in paediatric dentistry. It also covers tips that can be employed in the primary dental care setting such as the use of tooth mousse and silver diamine fluoride.

Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and Meta-Analysis

Children's dental health has become the main concern, due to the increase in caries prevalence amongst children. Pit and fissure sealant (PFS) and fluoride varnish (FV) are effective measures for preventing dental caries. However, the clinical efficacy of these interventions when compared to one another is uncertain. The aim of the present systematic review with meta-analysis was to compare pit and fissure sealants with fluoride varnish for caries prevention of first permanent molars among schoolchildren. This is a meta-Analysis, which involves randomized control trials that compare the effectiveness of PFS with FV within 24 months of follow-up. Five databases were searched from 1990 to 2019 to identify studies published in Arabic or English language. The risk ratio (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total number of 4 studies were included with overall of 1249 children in both groups. Three included trial reported caries increment of first permanent molars (FPM) with 24 months of follow-up, there was no statistical significance (RR: 0.65; 95% CI 0.31 to 1.35; P = 0.26 I2 = 89%). As regards DMFS increment, the analysis showed no statistical differences between FV and PFS in terms of lowering DMFS increment (MD: 0.09; 95% CI: -0.03 to 0.21). Findings of this meta-analysis proved there is no significant difference between PFS and FV in caries prevention efficacy of FPMs at 2 years' follow-up, emphasizing the use of FV since it is more affordable and easier to apply.

Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review

PURPOSE

Molar Incisor Hypomineralization (MIH) are first molars with developmental enamel defects and are common findings in many child populations. The porous nature of MIH enamel and the presence of post-eruptive enamel breakdown leads to the presence of hypersensitivity and pain, which is often the patient's main complaint and can result in dental fear and affect the quality of life. The present review aims to summarise the evidence for the ability of MIH to cause problems, such as dental fear and anxiety (DFA) and to summarise the evidence for a possibly negative impact on the oral health-related quality of life (OHRQoL) of MIH affected children and adolescents, in a systematic review.

METHOD

Two searches, (1) MIH AND dental anxiety and (2) MIH AND Quality of life, were performed in MEDLINE/PubMed and Scopus. Selection demands were fulfilling the MIH diagnosis criteria using validated instruments and questionnaires for assessing DFA and OHRQoL, respectively.

RESULTS

After removing duplicates and articles not fulfilling the selection demands, 6 studies concerning MIH and DFA and 8 studies concerning MIH and OHRQoL remained.

CONCLUSION

Children and adolescents with diagnosed MIH did not seem to suffer from increased dental fear and anxiety, but indicated an impaired oral health-related quality of life.

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.

Management of Patients with Poor Prognosis First Permanent Molars Beyond 'Ideal' Timing

The management of compromised first permanent molars is a common clinical conundrum in paediatric dentistry. Extensive guidance exists which supports the timed extraction of severely affected molars presenting at 8-10 years to allow favourable eruption of unaffected second permanent molars. However, treatment planning becomes more of a challenge when this window of opportunity is missed. In these situations, we are left with a tooth of guarded long-term prognosis in a patient where access and cooperation can be challenging. Delays to routine care as a result of the COVID-19 pandemic are likely to make this a more common clinical presentation so this article aims to discuss management options for these patients.

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

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

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

Background

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

Methods

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

Results

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

Conclusion

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

Molar Incisor Hypomineralisation: Current Knowledge and Practice

BACKGROUND

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Case report of a novel interim approach to prevent early posteruptive enamel breakdown of molar-incisor hypomineralization-affected molars

BACKGROUND AND OVERVIEW

Severely molar-incisor hypomineralization (MIH)-affected teeth are prone to develop early posteruptive enamel breakdown (PEB) and caries. A novel conservative interim approach for the prevention of this complication is presented.

CASE DESCRIPTION

A 6-year-old boy with strong hypersensitivity and extensive brown opacities in the partially erupted mandibular permanent first molars (PFMs) was diagnosed with MIH. Constant hygiene and dietary counseling were followed by the application of luted orthodontic bands and glass ionomer sealants to protect PFMs from caries and PEB until the complete eruption of the teeth. After 36 months, the PFMs were completely erupted, with no caries and PEB, and the cooperation of the child increased.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Temporary strategies are useful to preserve MIH-affected PFMs. With the methodology described, the hypersensitivity decreased and the patient reached a good degree of cooperation, making possible definitive rehabilitative considerations.

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Molar incisor hypomineralization: A review and prevalence in Japan

Molar incisor hypomineralization (MIH) is defined as hypomineralization of systemic origin of one to four first permanent molars, and incisors are also frequently affected. This disorder is a serious concern in pediatric dentistry. Teeth affected by MIH have many dental problems, such as hypersensitivity, poor aesthetics, and rapid progression of dental caries. The prevalence of MIH ranges from 2.8% to 21% among studies with more than 1000 subjects in different countries and age groups. The etiology of MIH is unclear, but genetic and environmental factors have been proposed. This review describes the prevalence, etiology, and clinical management of MIH. A detailed description of MIH prevalence in Japan is also provided.

White enamel lesions in children: considering caries, chronological and congenital causes and their consequent care

White enamel lesions are a common presentation to the general dentist and aesthetic concerns are the most frequent presenting problem. Aetiology may be multifactorial and management of such lesions is heavily dependent on the cause. In the paediatric patient, differentiating white lesions caused by caries, fluorosis and genetic and developmental disorders is key to offering optimal long-term treatment outcomes. Early intervention allows for carefully planned management of less common disorders. Many of these disorders exist along a spectrum, and white lesions offer a useful clue to prompt intervention and referral to the relevant specialists. This article overviews common white lesions of the teeth and outlines the hierarchy of management options available.

Molar and Incisor Hypomineralization

Molar and incisor hypomineralization is a developmental defect that is systemic in origin that affects one or more than one permanent first molars, and is often associated with permanent incisors. It is usually characterized by well demarcated opacities and qualitative enamel defects caused by decreased inorganic enamel components, and reduced mineralization. It can cause esthetic, functional, psychological, and behavioral problems in children. Its reported prevalence varies widely, from 2.5% to 40.2%. Multiple aspects of dental treatment for it are challenging, such as behavior management, difficulty in achieving adequate local anesthesia, tooth hypersensitivity, and retention of restorations. This review discusses the most important considerations pertaining to its prevalence, severity, etiology, differential diagnosis, and some of the challenges and treatment modalities applicable in young patients. Data is collected from PubMed, Medline, and Embase databases.

Management of molar-incisor hypomineralisation by general dental practitioners - part one: diagnosis

Introduction Molar-incisor hypomineralisation (MIH) affects one in six children in the UK. For the majority of patients who have mild MIH, this should be managed in primary care.Aims To assess UK-based general dental practitioners' (GDPs) ability to diagnose MIH when presented with multiple clinical vignettes.Design An electronic vignette survey was designed with use of clinical photographs - six cases had MIH and/or hypomineralised second primary molars (HSPMs) (seven possible diagnoses). Four control cases showing caries, fluorosis, amelogenesis imperfecta and dentinogenesis imperfecta were also included. Participants were UK-based GDPs. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Seventy-six GDPs completed the survey; 68.4% (n = 52) of participants were female and 83% (n = 63) of participants graduated after the year 2000. The number of accurate diagnoses for each case were as follows - mild MIH (molars/incisors) 65.79%; mild MIH (molars only) 3.95%; HSPM and MIH (HSPM result) 0%; HSPM and MIH (MIH result) 50%; severe MIH (post-eruptive breakdown) 63.16%; severe MIH (caries) 31.58%; HSPM 3.95%.Conclusion GDPs are able to accurately diagnose MIH best when both incisors and molars are affected and caries is not present.

Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

OBJECTIVE

To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7-11 years.

DESIGN

Service evaluation.

SETTING

UK dental teaching hospital.

METHODS

Retrospective analysis of FPM extraction patterns in patients aged 7-11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period).

RESULTS

A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs.

CONCLUSION

Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy's and St Thomas' Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

Molar Incisor Hypomineralization (MIH) in a Child with Congenital Chronic Intestinal Pseudoobstruction (CIPO)

Molar incisor hypomineralization (MIH) is a qualitative enamel defect of systemic origin affecting 1-4 permanent first molars (PFMs) frequently in association with affected permanent incisors (PIs). The exact etiology of MIH is still unclear but considered to be multifactorial. This present case report to the best of our knowledge is the first case reported which acknowledges MIH in a patient with chronic intestinal pseudoobstruction (CIPO) with underlying neurological disease due to somatic mitochondrial disorder. It also elicits the availability of various contemporary treatment options and their proper selection and early intervention to manage the functional and aesthetic problems caused by enamel defects and to improve the quality of life in the patients.