Hypomineralized Second Primary Molars as Predictor of Molar Incisor Hypomineralization

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.

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.

Dental treatment provided to special needs children under general anesthesia in a tertiary care hospital - A cross sectional retrospective study

Dental general anesthesia (DGA) can be a preferred approach for treating children with special health needs (CSHCN). It has many benefits, most importantly, the support of the anesthesia team to control the medical status and treat the patient safely. The aim of this study was to evaluate the dental treatment provided to (CSHCN) under (DGA) in a tertiary-care hospital. Moreover, to compare the dental procedures between different medical conditions. This retrospective study involves a sample of 730 children aged between (1-16 years) with complex medical conditions treated under DGA between January 2009 until April 2022. The results show that 4.93 % of these patients had DGA twice. For those children who had DGA only once, the most frequent medical conditions were neuro-developmental disorders (31.8 %), pediatric oncology (17.4 %), and behavioral disorders (autism, ADHD, etc.) (15.1 %). The average age was 6.9 years; almost half were preschool children (4-6 years old, 48.41 %) followed by younger school children (7-9 years old, 28.82 %). The most common dental procedures done were extractions followed by restorative procedures. The use of fissure sealant was significantly higher in neuro-developmental and behavioral disabilities patients than other medical conditions.

Dental Developmental Defects: A Pilot Study to Examine the Prevalence and Etiology in a Population of Children between 2 and 15 Years of Age

Dental development defects (DDDs) are quantitative and/or qualitative alterations produced during odontogenesis that affect both primary and permanent dentition. The etiology remains unknown, being associated with prenatal, perinatal, and postnatal factors. The aims were to identify the possible etiological factors, as well as the prevalence of DDDs in the primary and permanent dentition in a pediatric population. Two hundred twenty-one children between 2 and 15 years of age, patients of the master's degree in Pediatric Dentistry of the Complutense University of Madrid, were reviewed. DDDs were observed in 60 children. Next, a cross-sectional, case-control study was carried out (60 children in the control group and 60 children in the case group). The parents or guardians completed a questionnaire aimed at identifying associated etiological factors. The prevalence of DDDs in patients attending our master's program in both dentitions was 27.15%. Otitis, tonsillitis, high fevers, and medication intake stood out as the most relevant postnatal factors among cases and controls. The permanent maxillary right permanent central incisor and the primary mandibular right second molar were the most affected; there were no differences in relation to gender. One out of three children who presented DDDs in the primary dentition also presented DDDs in the permanent dentition. Prenatal and postnatal etiological factors showed a significant relationship with DDD alterations, considered risk factors for DDDs in both dentitions.

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.

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.

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.

Etiological Factors of Molar Incisor Hypomineralization: A Systematic Review and Meta-Analysis

Molar incisor hypomineralization (MIH) is a defect of the dental enamel that predominantly affects first molars and permanent incisors. Identifying the significant risk factors associated with MIH occurrence is essential for the implementation of prevention strategies. The purpose of this systematic review was to determine the etiological factors associated with MIH. A literature search was carried out from six databases until 2022; it covered pre-, peri-, and postnatal etiological factors. The PECOS strategy, PRISMA criteria, and the Newcastle-Ottawa scale were used, and 40 publications were selected for qualitative analysis as well as 25 for meta-analysis. Our results revealed an association between a history of illness during pregnancy (OR 4.03 (95% CI, 1.33-12.16), p = 0.01) and low weight at birth (OR 1.23 (95% CI, 1.10-1.38), p = 0.0005). Furthermore, general illness in childhood (OR 4.06 (95% CI, 2.03-8.11), p = 0.0001), antibiotic use (OR 1.76 (95% CI, 1.31-2.37), p = 0.0002), and high fever during early childhood (OR 1.48 (95% CI, 1.18-1.84), p = 0.0005) were associated with MIH. In conclusion, the etiology of MIH was found to be multifactorial. Children with health disorders in the first years of life and those whose mothers underwent illnesses during pregnancy might be more susceptible to MIH.

Enamel Phenotypes: Genetic and Environmental Determinants

Dental enamel is a specialized tissue that has adapted over millions of years of evolution to enhance the survival of a variety of species. In humans, enamel evolved to form the exterior protective layer for the crown of the exposed tooth crown. Its unique composition, structure, physical properties and attachment to the underlying dentin tissue allow it to be a resilient, although not self-repairing, tissue. The process of enamel formation, known as amelogenesis, involves epithelial-derived cells called ameloblasts that secrete a unique extracellular matrix that influences the structure of the mineralizing enamel crystallites. There are over 115 known genetic conditions affecting amelogenesis that are associated with enamel phenotypes characterized by either a reduction of enamel amount and or mineralization. Amelogenesis involves many processes that are sensitive to perturbation and can be altered by numerous environmental stressors. Genetics, epigenetics, and environment factors can influence enamel formation and play a role in resistance/risk for developmental defects and the complex disease, dental caries. Understanding why and how enamel is affected and the enamel phenotypes seen clinically support diagnostics, prognosis prediction, and the selection of treatment approaches that are appropriate for the specific tissue defects (e.g., deficient amount, decreased mineral, reduced insulation and hypersensitivity). The current level of knowledge regarding the heritable enamel defects is sufficient to develop a new classification system and consensus nosology that effectively communicate the mode of inheritance, molecular defect/pathway, and the functional aberration and resulting enamel phenotype.

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 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.

Retrospective Cohort Study on Potential Risk Factors for Repeated Need of Dental Rehabilitation under General Anesthesia in a Private Pediatric Dental Practice

The need for dental rehabilitations under general anesthesia (DRGAs) is continuously increasing, particularly for dental treatment of children. The present retrospective cohort study aimed to investigate potential risk factors for repeated need of DRGA in a cohort of patients from a private pediatric dental practice. Demographic and anamnestic data, dental status, and treatments performed during DRGA were retrospectively analyzed from the electronic dental charts of 1155 children that received at least one DRGA between October 2016 and December 2021. The median age of all children was 5 years at time of their first DRGA. The rate of repeated DRGAs was 9%. Patients with repeated need of DRGA were significantly younger at time of their first DRGA and revealed significantly more often a history of preterm birth and current use of a baby bottle as compared to patients with only one DRGA. There were significantly fewer treatments (regardless of type) in the second DRGA than at the first. Within the limitations of this study, young age at first DRGA, a history of preterm birth, and current use of a baby bottle may be risk factors for repeated need of DRGA. The search for effective strategies to minimize the repeated need for DRGA in children remains critical.

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

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

Aim and objective

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

Materials and methods

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

Results

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

Conclusions

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

How to cite this article

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

Childhood malnutrition and hypo mineralized molar defects ;a cross sectional study, Egypt

Background:  Malnutrition is well-known to yield high morbidities and it has pre-eruptive and post-eruptive consequences. The objective of the study was to evaluate the prevalence of Hypomineralized Second Primary Molars (HSPM), Molar Incisor Hypomineralization (MIH) and dental caries in malnourished children, as well as addressing the relation between types of malnutrition and the dental morbidities.

Methods: This is a cross sectional analytical study. A consecutive sample of 54 malnourished cases aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University across 6 months period were examined for HSPM, MIH – using the  European Academy of Pediatric Dentistry criteria - and dental Caries using def/ DMF indices. Outcomes were the presence or absence of MIH and HSPM and their levels measured as percentage as well as Caries Indices. Exposures were types of malnutrition and the socioeconomic status.

  Results :  The mean age of study participants was 7.10 ± 1.34 years. HSPM and MIH were found in 47.2% and 45.2% of the study participants respectively, while dental caries was observed in 83% and 64.3% for primary and permanent teeth respectively. There was co-occurrence between HSPM and MIH in 39% of the cases.

HSPM level was significantly different in various types of malnutrition. It showed significant difference between the stunted group (median HSPM of 14.2%) and the overweight or obese group (median HSPM of 0.0%) (P value 0.01). MIH level showed significant differences between the stunted group (median MIH of 19.4%) and overweight or obese group (median MIH of 0.0%) (p value 0.001), as well as between the stunted group (median MIH of 19.4%) and wasted group (median MIH of 0.0%) (p value 0.025).

Conclusions : Malnourished children have high prevalence of dental abnormalities. HSPM could expect the presence of MIH.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The 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.

Childhood malnutrition and hypo mineralized molar defects: a cross sectional study

Background:  Malnutrition is well-known to yield high morbidities and mortalities and considering its consequence on the oral cavity, malnutrition is shown to have pre-eruptive and post-eruptive outcomes. The objective was to assess the prevalence of hypo-mineralized second primary molar (HSPM), molar–incisor hypo-mineralization (MIH) and dental caries in malnourished children as well as addressing the relation between types of malnutrition of the children and their dental morbidities represented in HSPM, MIH and dental caries. Methods: This is a cross sectional analytical study. Malnourished children aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University were examined for HSPM. MIH using European Academy of Pediatric Dentistry criteria and dental Caries using def/ DMF indices. Results:  A consecutive sample (a long six months) of 54 malnourished children were enrolled in the study. Dental caries was a greater dental morbidity in the overweight and obese group. Besides, stunting was a greater risk in HSPM and MIH. There was an association between HSPM and MIH in a considerable percentage of the study group. Conclusions: Malnutrition is a risk factor for dental abnormalities. HSPM could expect the presence of MIH.

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.

A Four-Year Follow-Up Case Report of Hypomineralized Primary Second Molars Rehabilitated with Stainless Steel Crowns

Hypomineralized primary second molars (HPSM) are characterized by enamel opacities accompanied by hypersensitivity and atypical caries lesion, on one to four primary second molars. The correct treatment and follow-ups of those teeth have an important impact on a correct eruption of the first permanent molars and future occlusion. Hence, this report aims to describes a case of a severe HPSM in all second molars of a four-year-old girl and subsequent four-year follow-ups. The rehabilitation involved the placement of four stainless steel crowns on all four second primary molars under general anesthesia. Concerning the available literature and the case severity of HPSM, the treatment approach proposed for the case provided good functional outcome.

Utilising surface-level data to explore surface, tooth, individual and family influence on the aetiology of hypomineralised second primary molars

OBJECTIVES

Hypomineralised second primary molars (HSPM) are common developmental enamel defects. The aims of this study were to use surface-level data to explore the clustering of HSPM at four levels (family, child, tooth, surface).

METHODS

This study of 172 twin pairs was nested within the Peri/postnatal Epigenetic Twin Study. HSPM was measured by standardised oral examinations at age 6 years. Multilevel logistic regression models were fitted to assess the correlation structure of surface level data and variation in HSPM. The associations between surface level risk factors and HSPM were then explored using the multilevel logistic regression model using the best fitting correlation structure.

RESULTS

The prevalence of HSPM was 68 (19.8%) children, with a total of 141 (10.3%) teeth and 264 tooth surfaces (6.3%) affected. Multilevel models revealed that a hierarchical structure accounting for correlation at the family, child and tooth level best accounted for the variation in HSPM. The estimated variances from the best fitting model (Model 3) were largest at the family level (12.27, 95% CI 6.68, 22.51) compared with 5.23 at the child level and 1.93 at the tooth level. Application of regression analysis utilising this three-level correlation structure identified tooth/surface level factors in addition to the previously identified familial and individual risk factors for HSPM.

CONCLUSION

In addition to familial (environmental and genetic) and unique child-level factors, the aetiology of HSPM is likely to be influenced by local tooth-level factors.

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

Aim

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

Methods

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

Results

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

Conclusion

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

Molar Incisor Hypomineralization: Clinical Characteristics with Special Emphasis on Etiological Criteria

Molar incisor hypomineralization (MIH) is an entity to describe the enamel defects of the first permanent molars with the involvement of one or more incisors due to an underlying systemic cause. It is a frequently encountered challenge by dentists in a dental clinic and dental complications affecting patient's quality of life. Early diagnosis is the key to protect and prevent the deterioration of the condition. This article aims to highlight different aspects of etiology to treatment options in young patients related to MIH.

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.

Primary Teeth Stains and Discoloration: A Review

The current review assesses the literature concerning the etiology of primary teeth staining and discoloration. The appearance of the dentition is of concern to many children and their caregivers seeking dental treatment as the color of the teeth is of aesthetic importance. The correct diagnosis of the cause of the discoloration is important as, invariably, it has a profound effect on treatment outcomes. It would seem reasonable, therefore, that dental practitioners understand the etiology of tooth discoloration to make a diagnosis and enable appropriate treatment to be conducted. Knowledge of the etiology of tooth staining is of importance to the dental practitioner to explain the patient the exact nature of the condition. In some instances, the mechanism of staining affects the outcome of the treatment and influences the options the dentist will be able to offer. Many of these contributing factors are preventable if parents are educated, managed by professional interventions, or provide a multidisciplinary approach. In this review, we highlight the importance of children smiles and the difference between primary and permanent teeth. We discuss the different types of primary teeth staining and discoloration and whether it is intrinsic or extrinsic, as well as the different impacts of some conditions on primary teeth compared with permanent teeth.

Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study

BACKGROUND

Molar incisor hypomineralization (MIH) is a growing health problem, and its treatment is a challenge. The purpose of the present study was to evaluate and compare the perceptions, knowledge, and clinical experiences of MIH in general dental practitioners (GDPs) and paediatric dentists (PDs) in Spain.

METHODS

All dentists belonging to the College of Dentists of the Region of Murcia, in the South-East of Spain, were invited to participate in a cross-sectional survey. They were asked to complete a two-part questionnaire including sociodemographic profiles and knowledge, experience, and perceptions of MIH. Data were analysed using Pearson's chi-square test, Fisher's exact test and Cramer's V test.

RESULTS

The overall response rate was 18.6% (214/1147). Most respondents were aged 31-40 years (44.86%), with more than 15 years of professional experience (39.72%). They worked mainly in the private sector (84.58%) and were licensed in dentistry (74.30%): 95.45% of PDs had detected an increase in the incidence of MIH in recent years (p <  0.001). Only 23.80% of GDPs claimed to have made a training course on MIH. With respect to the aetiology, chronic medical conditions (p = 0.029) and environmental pollutants (p = 0.008) were the only factors that showed significant between-group differences. Durability (p = 0.009) and remineralization potential (p = 0.018) were the factors where there was a between-group difference in the choice of the restoration material. In the case of post-eruptive fractures and opacities, the preferred material for both groups was resin-modified glass ionomer (RMGIC). However, in incisor lesions, composite was the material of choice for both groups, with significant differences (p = 0.032) in the use of glass ionomer. Most respondents expressed a need for continuing education on MIH.

CONCLUSION

Spanish dentists perceived an increase in the incidence of MIH. The material of choice was RMGIC for non-aesthetic sectors and composite for incisors. Dentists believe it is difficult or very difficult to manage MIH, since the long-term success of restorations of MIH lesions is compromised because resin adhesion is not good. Both GDPs and PDs believe they need more training on the aetiology, diagnosis, and treatment of MIH.

Prevalence of Molar-Incisor Hypomineralization and Caries in Eight-Year-Old Children in Croatia

The aim of this study was to detect molar–incisor hypomineralization (MIH) and caries prevalence in eight-year-old children with early mixed dentition in Eastern Croatia. There is a lack of data on MIH in Croatia. There were 729 children examined in total: 356 (48.83%) were female and 373 (51.16%) were male. The presence of MIH was found in 95 children, the prevalence of MIH was 13%, and the remaining 634 (87%) did not have any changes associated with MIH. The prevalence of caries overall in the population of examined children was 11.48%. In the group of children with MIH, the prevalence of caries was 24.14%, while in the group of children with no MIH, the prevalence of caries was 11.18%. Teeth had a Decayed, Missing, and Filled Teeth (DMFT) index of 1.2, the value of the SiC index was 1.4, and the decayed, missing, and filled teeth (dmft) index for deciduous teeth was 5.8. Children with MIH had a caries index of DMFT 2.1, and the value of the SiC index was 2.6. The index of caries for non-MIH children was DMFT 1.1 and the SiC index was 1.2. MIH prevalence in Croatia is more common in girls than in boys. MIH has a significant impact on children’s development and is a major factor in the occurrence of caries.

Prevalence of molar-incisor-hypomineralisation (MIH) among 6-12-year-old children in Central Hesse (Germany)

AIM

The aim of the present cross-sectional study was to assess and compare the prevalence of MIH among 6-12-year-old school children living either in a rural area of Central Hesse (Germany) or in the city of Frankfurt on the Main (Germany). A possible association between hypomineralised second primary molars (HSPM) and MIH was investigated. Furthermore, the MIH prevalence data of the rural area were compared with those of a previous study conducted in this area in the school year 2002/2003.

METHODS

In the school year 2014/2015, 2103 children (6-12 years of age) were examined during the annual school-based dental examinations prescribed by law at nine schools in the rural area of Central Hesse (LDK) and five schools in the city of Frankfurt on the Main (Ffm). Eight previously calibrated dentists working for the public healthcare authorities assessed the prevalence of HSPM/MIH (EAPD criteria/severity scale by Wetzel and Reckel) and the caries experience (dmft/DMFT).

RESULTS

The prevalence of HSPM/MIH amounted 3.2%/9.4% in LDK and 2.9%/17.4% in Ffm. In the majority of cases, children with MIH had demarcated opacities. In LDK, hypomineralised first permanent molars were most commonly affected by severity degree 2, whereas in Ffm, severity degree 1 was predominant. Children suffering from HSPM had an odds ratio of 11.32 (95% CI: 6.73-19.03) for having MIH as well. Compared with the results of 2002/2003 in LDK (prevalence of MIH 5.9%), the MIH prevalence increased by 3.5% in the rural area. All in all, the caries experience among children under investigation was low (DMFT 0.14-0.15).

SIGNIFICANCE

MIH may be diagnosed in school children living in different areas of Germany with regional variations (rural-urban comparison). The presence of HSPM is of predictive value for MIH. The increasing number of hypomineralised first permanent molars over 12 years of time in the rural area indicates a need for further investigation on the aetiology of MIH.

Molar Incisor Hypomineralization: Etiology, Clinical Aspects, and a Restorative Treatment Case Report

CLINICAL RELEVANCE

Total-etch adhesive systems and resin composite are clinically viable dental materials for esthetic restorations in teeth presenting white/yellow/brown hypomineralization stains.

SUMMARY

Molar-incisor hypomineralization (MIH) is a condition that negatively affects enamel and dentin, especially the first molars and permanent incisors, causing esthetic and functional problems. The present clinical case report presents and discusses the etiology and clinical characteristics of MIH and describes a restorative protocol for MIH-affected teeth.

Prevalence of hypomineralised second primary molars (HSPM) in Syrian preschool children

AIM

The objective of this research was to determine the incidence and severity of HSPM and its association with caries in 4-5 year-old children in Latakia, Syria.

METHODS

A cross-sectional study was carried out with 600 preschool children. The European Academy of Pediatric Dentistry (EAPD) criteria were used for scoring HSPM. The decayed, missing and filled teeth (dmft) index was used to evaluate caries status.

RESULTS

The prevalence of HSPM was 41%. The difference in HSPM prevalence between males and females was not statistically significant (p > 0.05). Children with HSPM are more likely to have dental caries (OR 6.69; CI 4.5_10; p < 0.001).

CONCLUSIONS

The prevalence of HSPM was relatively high in Syrian children. HSPM increases the incidence of caries.

Pre-term birth and asthma is associated with hypomineralized second primary molars in pre-schoolers: A population-based study

BACKGROUND

Hypomineralized second primary molar (HSPM) is a developmental enamel defect that represents a caries-risk factor. There are few studies about HSPM epidemiology in representative populations.

AIM

To determine the prevalence and factors associated with HSPM in pre-schoolers.

DESIGN

This is a cross-sectional population-based study of 5-year-old pre-schoolers from Teresina, Brazil. The sample was randomly selected and stratified by geographic region of the city, type of school (public and private), and sex of the pre-schoolers (n = 811). Sociodemographic status and pre-, peri-, and post-natal conditions were collected by structured questionnaires. Two calibrated examiners diagnosed HSPM using the criteria of the European Academy of Paediatric Dentistry for molar-incisor hypomineralization. Severity, colour, location, and extent of lesions were also evaluated. Descriptive analysis of the data and a Poisson regression analysis were performed (P < .05).

RESULTS

The prevalence of HSPM was 14.9. Demarcated opacities (75.6%) and white/cream colour were the most prevalent (71.4%). Pre-term pre-schoolers had 66% (PR = 1.66, 95% CI = 1.07-2.58), and those who reported asthma in the first year of life had 69% (PR = 1.69, 95% CI = 1.01-2.85) higher prevalence of HSPM.

CONCLUSIONS

Pre-term birth and reported asthma in the first year of life were associated with HSPM. The prevalence of HSPM in pre-schoolers aged 5 years old in Teresina was high.

Elements of morphology: Standard terminology for the teeth and classifying genetic dental disorders

Dental anomalies occur frequently in a number of genetic disorders and act as major signs in diagnosing these disorders. We present definitions of the most common dental signs and propose a classification usable as a diagnostic tool by dentists, clinical geneticists, and other health care providers. The definitions are part of the series Elements of Morphology and have been established after careful discussions within an international group of experienced dentists and geneticists. The classification system was elaborated in the French collaborative network "TÊTECOU" and the affiliated O-Rares reference/competence centers. The classification includes isolated and syndromic disorders with oral and dental anomalies, to which causative genes and main extraoral signs and symptoms are added. A systematic literature analysis yielded 408 entities of which a causal gene has been identified in 79%. We classified dental disorders in eight groups: dental agenesis, supernumerary teeth, dental size and/or shape, enamel, dentin, dental eruption, periodontal and gingival, and tumor-like anomalies. We aim the classification to act as a shared reference for clinical and epidemiological studies. We welcome critical evaluations of the definitions and classification and will regularly update the classification for newly recognized conditions.

Molar incisor hypomineralisation (MIH) - an overview

Recent data indicates that molar-incisor hypomineralisation (MIH) is a frequently - encountered dental condition worldwide. The condition could be associated with dental complications that might affect patients' quality of life as well as create treatment challenges to dentists. The affected teeth are more prone to caries and post-eruptive enamel breakdown, therefore, it is believed that this condition might be responsible for a substantial proportion of childhood caries since the condition has high prevalence. MIH is common, and as such it should be diagnosed and managed in primary care wherever possible. Early diagnosis can lead to more effective and conservative management. This article aims to highlight different aspects related to MIH, from its prevalence to treatment options in young patients.

Dental hypomineralization treatment: A systematic review

INTRODUCTION

Defects in the maturation stage of amelogenesis result in a normal volume of enamel but insufficient mineralization, called hypomineralization. Molar-incisor hypomineralization (MIH), amelogenesis imperfecta and dental fluorosis (DF) are examples of such defects.

OBJECTIVE

To evaluate the effectiveness of the treatments applied to the different forms of dental hypomineralization.

MATERIALS AND METHODS

PubMed, Scopus, Cochrane Library, Web of Science, and Embase were screened. The research was limited to studies published in English, Spanish, and Portuguese, until May 30, 2018. The research question was formulated following the Population, Intervention, Comparison, Outcome strategy. The quality of the methodology of each article was evaluated employing the Cochrane Handbook for Systematic Reviews.

RESULTS

From the initial research, 7895 references were obtained, of which 33 were included in the systematic review. The following treatments were reported: desensitizing and remineralizing products, resin infiltration, restorations, fissure sealants, tooth bleaching, enamel microabrasion and calcium, and vitamins supplements.

CONCLUSIONS

Although the results are suggestive, there is a clear need for a greater uniformity of the methodologies, thus allowing for the development of clinical guidelines. Nevertheless, it was possible to identify several effective treatments for teeth with MIH (arginine pastes or fluoride varnishes) and DF (tooth bleaching and/or enamel microabrasion).

CLINICAL SIGNIFICANCE

Because MIH, amelogenesis imperfecta, and DF are commonly seen in dental daily practice, it is extremely important to analyze the literature regarding its treatment.

Etiology of Hypomineralized Second Primary Molars: A Prospective Twin Study

The etiology of hypomineralized second primary molars (HSPM) is unclear, but genetic and environmental factors have been proposed. The aim of this study was to investigate the relative contribution of genes and environment to the etiology of HSPM and to identify potential environmental risk factors in a longitudinal twin cohort. Children from twin pregnancies ( N = 250) were recruited antenatally, and detailed demographic, health, and phenotypic data were collected at recruitment, 24- and 36-wk gestation, birth, and 18 mo of age. 25-Hydroxyvitamin D was quantified for mothers at 28-wk gestation and infants at birth. Dental examinations were conducted on the twins at 6 y of age to determine the presence, severity, and extent of HSPM per standardized criteria. To investigate associations of environmental risk factors with HSPM, multiple logistic regression models were fitted with generalized estimating equations to adjust for twin correlation. Within- and between-pair analyses were performed for unshared continuous variables: birthweight and birth 25-hydroxyvitamin D. Twin-twin concordance for monozygotic (MZ) and dizygotic (DZ) pairs was calculated and compared after adjusting for identified risk factors. A total of 344 twins underwent the 6-y-old dental assessment; HSPM occurred in 68 (19.8%). After adjusting for potential confounders, vitamin D levels at birth, infantile eczema, dizygosity, in vitro fertilization, socioeconomic position, and maternal smoking beyond the first trimester of pregnancy demonstrated the strongest associations with HSPM. Overall concordance for HSPM was 0.47 (95% CI, 0.32 to 0.62) with weak evidence ( P = 0.078) of higher concordance in MZ twins (0.63; 95% CI, 0.38 to 0.89) as compared with DZ twins (0.41; 95% CI, 0.24 to 0.58). After adjusting for known risk factors, there was no evidence ( P = 0.172) for an additive genetic influence. These findings suggest that shared and unshared environmental factors, such as maternal smoking later in pregnancy and infantile eczema, are important in the etiology of HSPM.

Are hypomineralised lesions on second primary molars (HSPM) a predictive sign of molar incisor hypomineralisation (MIH)? A systematic review and a meta-analysis

OBJECTIVES

Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) involve qualitative structural developmental anomalies of tooth enamel affecting the first permanent molars (and often incisors) and the second primary molars, respectively. A putative relationship between HSPM and MIH has been reported in the scientific literature. The aim was to determine whether children with HSPM are more likely to develop MIH.

SOURCE

A systematic search using PubMed/Medline, Embase and Cochrane Library electronic databases for publications from 2001 to August 2017 investigating the link between MIH and HSPM was undertaken.

STUDY SELECTION

Four reviewers selected the studies independently, extracted the data according to PRISMA statement, and assessed the bias risk with the Newcastle-Ottawa Scale (NOS) criteria.

RESULTS

From 645 potentially eligible studies, 14 were selected for full text analysis and 5 were included in the meta-analysis. Cross-sectional and cohort studies were reported and 4662 participants were included. The meta-analyses were performed with a random model calculated an OR total of 4.66 (95% CI 2.11-10.26; P < 0.001). The weighted mean of the co-occurrence of HSPM and MIH prevalence was 19.94%.

DISCUSSION

The high heterogeneity (I² = 88%) can be explained by the great variation present in number of participants and variable caries risk. Despite the limitations of the study, the presence of HSPM is predictive for MIH, with greater MIH prevalence in the presence of mild HSPM.

CLINICAL SIGNIFICANCE

Early detection and preventive intervention could reduce MIH complications.

Dentists' perception, knowledge, and clinical management of molar-incisor-hypomineralisation in Kuwait: a cross-sectional study

Background

Molar-incisor Hypomineralisation (MIH) is considered as a global dental problem. There is little knowledge of general dental practitioners (GDPs) and dental specialists (DSs) about this condition in different parts of the world, particularly in Gulf Cooperation Council (GCC) countries. Hence, this study has been carried out to assess the knowledge of GDPS and DSs in Kuwait about MIH condition, its clinical presentation and management. Findings would help national school oral health program (SOHP) to promote good oral healthcare.

Methods

A structured questionnaire was distributed to 310 attendees of the 18th Kuwait Dental Association Scientific Conference, Kuwait. Data concerning demographic variables, prevalence, diagnosis, severity, training demands and clinical management of MIH were collected.

Results

A response rate of 71.3% (221/310) was reported. 94% of respondents noticed MIH in their practice. Yellow/brown demarcation has been observed as a common clinical presentation (> 50%). Almost 10–20% of MIH prevalence has been reported by the participants. Resin composite was the dental material often used in treating MIH teeth (~ 65%), and fewer than half would use it for treating moderately affected molars. Most respondents would use preformed metal crowns for severe MIH (63%). Dental journals were the information source for DSs; whereas, the internet was the information source for GDPs. Child’s behaviour was the main reported barrier for treatment of MIH affected children. Many GDPs felt unconfident when diagnosing MIH compared to dental specialists. Respondents supported the need to investigate MIH prevalence and to receive a clinical training.

Conclusions

Molar incisor hypomineralisation is a recognised dental condition by practitioners in Kuwait. Yellow/brown demarcated opacities were the most reported clinical presentation, and the composite resin was the most preferred dental material for restoring MIH teeth. Most GDPs and dental specialists would use preformed metal crowns for severely affected molars. GDPs reported low levels of confidence in MIH diagnosis which necessitates conducting continuing education courses to provide high- quality dental care for children with MIH.

Foetal, neonatal and child vitamin D status and enamel hypomineralization

Objectives

Recent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six.

Methods

Our study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983).

Results

The children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16).

Conclusions

25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.

Degree of severity of molar incisor hypomineralization and its relation to dental caries

Molar incisor hypomineralization is a developmental defect of dental enamel associated with rapid caries progression. In order to discover whether molar incisor hypomineralization predisposes to dental caries, a cross-sectional cohort study was conducted in a sample of 414 children aged between eight and nine years. It was found that 24.2% of the children presented molar incisor hypomineralization. Of these, 72% had a mild form and 28% a severe form. Caries prevalence was greater among the children with severe form (60.7%) than in those with mild form (43.1%) or no molar incisor hypomineralization (45.5%). The caries indices were higher in out molar incisor hypomineralization (1.18) or with mild form (1.08). The tooth-surface caries ratio was significantly higher in surfaces with severe hypomineralization than in those with no hypomineralization or mild hypomineralization. A linear regression model showed that cariogenic food intake and the presence of severe molar incisor hypomineralization were significantly associated with DMFS. Consequently, an association was found to exist between dental caries and the presence of surfaces affected by severe molar incisor hypomineralization, which should be considered a risk factor within the multifactorial etiology of caries.

Analytical evidence of enamel hypomineralisation on permanent and primary molars amongst past populations

Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) involve prevalent qualitative structural developmental anomalies of tooth enamel affecting the first permanent molars (and often incisors) and the second primary molars, respectively. These demarcated hypomineralised lesions of enamel manifest as white-cream or yellow-brown opacities, with possible post-eruptive localised loss of enamel. Aetiological hypotheses have involved contemporary life factors (i.e. environmental pollutant exposure or early childhood medications) in contrast to factors not limited to a specific time period (i.e. hypoxia at birth or genetic predisposition). Evidence of MIH in ancient populations would reinforce aetiological factors present for many centuries. By means of microtomographic and X-ray fluorescence analyses the present study provides evidence that (i) two archaeological specimens: “S407” (Sains-en-Gohelle, France, 12^th–16^th centuries) and “B335” (Beauvais, France, 15^th–18^th centuries) were MIH-affected, and (ii) one individual “S323” was affected by HSPM and MIH (Sains-en-Gohelle, France, 7^th–11^th centuries).