Perception of molar-incisor hypomineralisation (MIH) by Iraqi dental academics

Perceptions, attitudes, and clinical experiences of Brazilian dental practitioners towards molar incisor hypomineralisation: a cross-sectional study

PURPOSE

To evaluate perceptions, attitudes, and clinical experience of Brazilian dental practitioners regarding molar incisor hypomineralisation (MIH).

METHODS

An online survey with 27 questions, covering professional profile data, perceptions, and knowledge on clinical management of MIH, was employed. Descriptive analyses, chi-square, Fisher's exact, and Cramer's V tests were used.

RESULTS

Sample comprised 100 participants, equally distributed between those working in private or public sectors. Most private sector practitioners had 21-30 years of clinical experience (28%) and master's degree (50%), while most public sector practitioners had 11-20 years of clinical experience (32%) and a PhD degree (32%). Most participants (86%) recognized MIH in their practice. Statistically significant differences were observed in frequency (p = 0.001), incidence (p = 0.039), and lesion type (p = 0.043) between practitioners from both sectors. Uncertainly in management was reported by 49%, mainly in public sector. For mild MIH in incisors, no treatment was chosen (43%), and the treatment longevity was the only significant factor reported (p = 0.012). In cases of mild MIH in first permanent molars (FPMs), 51% of respondents opted to keep the affected tissue and apply fissure sealant. Glass ionomer (GI) restoration was commonly indicated for FPMs with severe MIH with moderate loss of structure and sensitivity (38%). In cases with substantial structural loss and pulpal involvement, the most chosen treatment was endodontic intervention combined with preformed crowns.

CONCLUSION

Brazilian dental practitioners face MIH in clinical practice. Although, public sector professionals are less confident in diagnosis and treatment, no significant differences in treatment preferences between public and private sector dental practitioners were identified.

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.

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.

Knowledge, experience, and perception of molar incisor hypomineralisation among dentists in the metropolitan area of Mexico City: a cross-sectional study

BACKGROUND

Molar-incisor hypomineralisation (MIH) is the most common developmental abnormality observed in teeth. Being a relatively new condition, its treatment can present a challenge for the dentist. There is currently no study available that has evaluated the knowledge of Mexican dental personnel. This study aimed to evaluate the knowledge, experience, and perceptions of dental surgeons regarding the detection, assessment, and treatment of MIH in the metropolitan area of Mexico City.

METHODS

A cross-sectional study was designed. Dentists from Mexico City and its metropolitan area were invited through social networks to answer a questionnaire of 30 questions related to MIH. Participants were classified into general practice dentists, paediatric dentists, and other speciality dentists. Pearson's chi-square test was used for data analysis.

RESULTS

The questionnaire was answered by 391 dentists. A total of 86% (338 out of 391) of them identified MIH lesions, while 84% of them reported having observed MIH lesions in their practice. The most frequently observed lesions were yellow-brown opacities which accounted for 47% of the lesions, 46% were white opacities, while only 7% were observed as post-eruptive fractures in the enamel as part of the manifestations of MIH. The most frequently reported problem in the management of teeth with MIH was insufficient training for treating children with MIH. A total of 84% of dentists stated that they would like more information on the treatment of MIH lesions.

CONCLUSIONS

Most of the surveyed dentists recognised MIH and reported having observed MIH lesions in their practice. Most of the dentists indicated that the main problem for the management of the MIH is the lack of training.

General dentists' perceptions and clinical management of hypomineralised second primary molars (HSPM) in Ireland

PURPOSE

This questionnaire aimed to explore how general dentists in the Republic of Ireland perceive and manage hypomineralised second primary molars (HSPM).

METHODS

Following ethical approval, a validated structured questionnaire containing 19 questions was sent to Irish dentists using Survey Monkey. Questions on awareness, dentist's experience, barriers to care and clinical scenarios with different treatment options were included. Binary outcomes and independent variables were compared using logistic regression analysis (α = 5%).

RESULTS

Responses from 279 general dentists were analysed. The majority of dentists were aware of HSPM (72%) and most dentists felt confident in diagnosing HSPM (71%). Dentists who had practiced for ≥ 15 years were significantly more likely to document HSPM frequently compared to those with less experience (OR 0.29; p = 0.012). No significant association was found between confidence in HSPM diagnosis and other variables, such as age group, years of practice and workplace. Dentists not working in private practice reported to be less comfortable in the management of HSPM (OR 0.49; p = 0.030). The most cited barrier to management of HSPM was child's behaviour. A broad variation was observed in the clinical scenarios, in particular when treatment planning more severe HSPM.

CONCLUSIONS

In general, Irish dentists are aware of HSPM and are confident in diagnosis and management. Variation existed in treatment options reflecting the disparity that exists in clinical management.

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

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

A cross-sectional survey on knowledge and attitudes of Greek dentists regarding molar incisor hypomineralisation diagnosis and treatment

Background

Molar Incisor Hypomineralisation (MIH) remains a challenge for clinicians underlining the gap in the literature regarding the condition. The study aimed to record knowledge and attitudes of Greek dentists regarding diagnosis and treatment of MIH and correlate findings with non-dental characteristics.

Methods

It is a cross-sectional study based on a questionnaire consisting of 37 multiple-choice questions. Data regarding diagnosis, aetiopathogenesis, and clinical management of MIH were collected from active members of three Greek Dental Associations. Chi-square and student’s t-test were used to correlate responses with practitioners’ characteristics and odds ratios calculated to evaluate differences on treatment of MIH-affected teeth (p < 0.05).

Results

From the 360 participants (response rate = 94%), 185 were general dental practitioners (GDPs) and 175 dental specialists (59 paediatric dentists (PDs), 38 orthodontists and 78 of other specialties).MIH was commonly encountered as a clinical problem, with GDPs reporting genetics and fluoride intake as common aetiological factors at significantly higher percentages as compared to PDs (p < 0.05). Permanent molars and incisors (44%) were the teeth most commonly affected, with yellow/brown demarcated opacities (68%) the most common clinical feature with PDs reporting them in a significantly higher percentage (p < 0.05). Dentists with specialisation, dentists that treat > 10 children per week and children with MIH-affected teeth had a 2–5.5 times greater probability to report difficulty achieving sufficient anaesthesia and hypersensitivity problems (p < 0.001). Agreement between GDPs’ and dental specialists’ views was found on less invasive treatment of anterior lesions. Non-PDs reported bulk-fill restorations and onlays as the ideal treatment of severely-affected posterior teeth, as compared to PDs that preferred preformed metal crowns (p < 0.05). Multivariate logistic regression analysis revealed that the age of the clinician, years of experience and number of children treated per week were the factors significantly associated with the decision for the treatment of only severely-affected posterior MIH teeth.

Conclusions

Most participants had encountered MIH-affected teeth in their clinical practice and were able to recognize main aetiological factors and clinical findings related to the condition. Nevertheless, their knowledge regarding treatment is limited.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02525-3.

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.

"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.

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.

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.

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.

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

BACKGROUND

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Management of molar-incisor hypomineralisation by general dental practitioners - part two: treatment

Introduction Molar-incisor hypomineralisation (MIH) is a common occurrence in primary and secondary care settings. While severe cases may need specialist care, mild cases should be managed in primary care.Aims To assess how UK-based general dental practitioners (GDPs) plan treatment for children with MIH using two clinical vignettesDesign An electronic vignette survey was designed using clinical photographs and radiographs. Vignette one presented a child with mild MIH who was unhappy about the appearance of his teeth. Vignette two presented an anxious child with severe MIH, caries and sensitivity. Further questions relating to confidence in management of MIH and referral were included. Participants were UK-based GDPs who regularly treat children. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Fifty-eight GDPs completed the survey. Around half of participants addressed the aesthetic concerns of the child in vignette one. The majority of participants demonstrated sound treatment planning in terms of preventive care and management of molars. More GDPs identified increased caries risk in vignette two.Conclusion These findings demonstrate most GDPs in this study were working as effective tier one and two providers when faced with management of children with MIH.

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.

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.

A questionnaire study on perception and clinical management of molar incisor hypomineralisation (MIH) by Irish dentists

AIM

Molar incisor hypomineralisation (MIH) is a significant global health problem frequently encountered by dentists. The aim of this questionnaire-based study was to gain a better understanding of how dentists in the Republic of Ireland perceive and manage MIH. In addition, to compare these findings with results of existing international studies.

METHODS

Following ethical approval, an online survey was created consisting of 16 questions based on previous surveys regarding perception and treatment of MIH. Photographs and information regarding three specific cases were also included. The questionnaire was distributed by email and the data were analysed using SPSS statistical software.

RESULTS

The total number of respondents was 230, of which 204 were general dentists. The majority of dentists (58%) reported that they observe MIH on a weekly basis. Those dentists exclusively in private practice and respondents aged 36 and older were less likely to note frequent MIH (p = 0.042). The vast majority of respondents felt either confident or very confident in diagnosing MIH (91%). Overall, 71% reported to feel comfortable managing MIH; however, those in private practice only (p = 0.023) and those aged 36 and older (p = 0.011) were less likely to report being comfortable managing MIH. The most commonly cited barrier to care was the child's behaviour, followed by difficulty in achieving local anaesthesia. Composite resin was the most commonly selected material used to restore teeth affected by MIH (84%). In the scenario on cavity design, the results showed a similar number of dentists selected the most conservative and the most aggressive preparation indicating a disparity among choices.

CONCLUSIONS

MIH is frequently encountered by Irish general dentists. The overall wide disparity of responses is in line with other studies, and further highlights the need for the development of strong treatment guidelines and continuing dental education to assist dentists in treatment planning for MIH.

Knowledge and Management of First Permanent Molars with Enamel Hypomineralization among Dentists and Orthodontists

Purpose: Molar Incisor Hypomineralization (MIH) is a developmental enamel anomaly of systemic origin affecting the first permanent molars and often the permanent incisors. Despite MIH being a prevalent anomaly, its diagnosis and management are challenging for practitioners; including poor anesthesia, failure of restorations, rapid enamel breakdown, poor resin adhesion, and related child anxiety. This study aimed to evaluate knowledge regarding and management of MIH amongst orthodontists and dentists. Study design: The study was performed from March to September 2017 and included 336 dentists and 32 orthodontists. Questionnaires comprised questions on MIH diagnosis, socio-demographic characteristics of the subjects, and photographs of a case of MIH with related questions regarding management. Results: Our results showed that 48% of dentists and 25% of orthodontists misdiagnosed MIH; with misdiagnosis associated with graduation prior to 1986 (p < 0.001). Amongst dentists, 59% applied a fluoridated product and 34% applied fissure sealants in the case of moderate MIH. The application of fluoride was associated with graduation after 1986 (p < 0.0001).Conclusion: Large disparities about knowledge and management of MIH exist between dental practitioners in France. Education regarding diagnosis and management of MIH is necessary.

Evaluating the changes in molar incisor hypomineralization prevalence: A comparison of two cross-sectional studies in two elementary schools in Mexico City between 2008 and 2017

BACKGROUND

Little information is available on the trends over time of the prevalence of molar incisor hypomineralization (MIH). This condition may be preventing dental caries decline.

AIM

(a) To compare the prevalence of MIH, in Mexico City schoolchildren, evaluated in 2008 with a group evaluated in 2017, (b) to identify the association of MIH with dental caries, and (c) to assess the mother's perception of her child's oral health status.

DESIGN

Two cross-sectional studies performed in 2008 and in 2017 were compared. The oral examiner and the selected schools were the same in both surveys.

RESULTS

A total of 549 schoolchildren were evaluated. The prevalence of MIH in the first survey was 20.3%, and 31.9 % in the second survey, (p = .002). Children with MIH were more likely to have dental caries. The odds ratio was 2.24 (p = .036) and 4.18 (p ˂ .001) in the first and second surveys, respectively. Mothers of children with MIH perceived worse oral health status of their children than the mothers whose children did not have MIH (odds ratio = 4.47, p ˂ .001).

CONCLUSION

The findings portray a clear increase in prevalence of MIH and highlight the need for increased awareness about this condition among dentists and the general population.

Second primary molar hypomineralisation and drugs used during pregnancy and infancy. A systematic review

OBJECTIVES

Hypomineralised second primary molars (HSPM) are due to idiopathic hypomineralisation that affects from 1- to 4-s primary molars, and its aetiology remains unclear. Our objective was to systematically review studies in which the investigators had studied the association between HSPM and drug use during pregnancy and the first year of life.

MATERIALS AND METHODS

A systematic search for publications until July 2018 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. No restrictions were placed on year of publication. The PECO Question was as follows: P, children exposed to drugs during pregnancy and the first year of life; E, drugs to which mothers, during pregnancy and their offspring were exposed; C, control groups from studies with the same characteristics not exposed to drugs during pregnancy and the first year of life; and O, relationship between drug exposure during pregnancy and the first year of life and HSPM. Two reviewers extracted the data and assessed the risk of bias using the Newcastle-Ottawa Scale criteria.

RESULTS

We initially identified 986 articles, or which seven were selected for review: two case-control studies, one cross-sectional studies and four cohort studies. Four studies reported data on drug consumption during pregnancy and four investigated drug use during the first year of life and the occurrence of enamel defects in primary dentition.

CONCLUSIONS

There is no clear evidence that the use of drugs during pregnancy and during the first year of life is associated with HSPM. Further well-designed prospective studies are needed.

CLINICAL RELEVANCE

Determining the etiological factors related to the development of HSPM would help to establish preventive protocols in patients at potential risk. As HSPM is predictive of molar incisor hypomineralisation (MIH), the application of preventive protocols would avoid complications in both the primary and permanent dentition.

Perception of Indian Dental Surgeons regarding Molar Incisor Hypomineralization

Aim

To determine the perception of Indian dental professionals about prevalence, severity, and etiological factors of molar incisor hypomineralization (MIH).

Materials and methods

An online survey was mailed to dental professionals encompassing various questions regarding etiology, diagnosis, prevalence, and management of MIH.

Results

More than 90% of the respondents encounter teeth with hypomineralization in their practice, with less than half of them encountering such teeth on a monthly basis. Among these more than one-third find it difficult to manage one or the other aspect of MIH. The etiology was found to be varying as per the respondents.

Conclusion

Molar incisor hypomineralization is a common condition encountered by dental professionals with no apparent consensus regarding the anticipated prevalence, severity, and etiology of this condition. Knowledge of clinicians' level of perception could be an incentive for pediatric dentists to become more acquainted with MIH by conducting research into its different aspects.How to cite this article: Upadhyay S, Kumar G, Dhillon JK, Gill NC. Perception of Indian Dental Surgeons regarding Molar Incisor Hypomineralization. Int J Clin Pediatr Dent 2018;11(2):116-121.

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.

Knowledge, experience and perceptions regarding Molar-Incisor Hypomineralisation (MIH) amongst Australian and Chilean public oral health care practitioners

Background

Molar-Incisor Hypomineralisation (MIH) is a prevalent developmental defect of tooth enamel associated with a high burden of disease. The present study aimed to survey Australian and Chilean oral health care practitioners (OHCPs) working in public dental facilities and to compare their knowledge, clinical experience and perceptions about MIH. Findings would give insights about how current knowledge has penetrated into OHCPs working into the public systems.

Methods

A mixed-mode survey regarding MIH was carried out amongst Australian and Chilean OHCPs from the public sector. The survey required responses to questions regarding sociodemographics, clinical experience, perceptions, clinical management and preferences for further training. The level of knowledge regarding MIH was determined by Delphi methods for consensus. Data analysis utilised Chi-square, linear and logistic regression models using SPSS Ver. 22.0.

Results

The majority of respondents had observed MIH in their patients (88.6 %) and the level of knowledge regarding MIH was high in Australian participants (p = 0.03). Australian respondents felt more confident when diagnosing (OR 8.80, 95 % CI 2.49–31.16) and treating MIH-affected children (OR 4.56, 95 % CI 2.16–9.76) compared to Chilean respondents. Oral health therapists reported higher levels of confidence than Australian general dental practitioners when providing treatment to children with MIH (OR 7.53; 95 % CI 1.95–29.07).

Conclusions

Continuing to update clinical guidelines may help practitioners increase their understanding when diagnosing and treating MIH-affected children. Dissemination of information and awareness regarding MIH is necessary in public clinics, and in particular Chilean general dental practitioners should be alerted to these factors.

A practical method for use in epidemiological studies on enamel hypomineralisation

With the development of the European Academy of Paediatric Dentistry (EAPD) judgment criteria, there has been increasing interest worldwide in investigation of the prevalence of demarcated opacities in tooth enamel substance, known as molar–incisor hypomineralisation (MIH). However, the lack of a standardised system for the purpose of recording MIH data in epidemiological surveys has contributed greatly to the wide variations in the reported prevalence between studies. The present publication describes the rationale, development, and content of a scoring method for MIH diagnosis in epidemiological studies as well as clinic- and hospital-based studies. The proposed grading method allows separate classification of demarcated hypomineralisation lesions and other enamel defects identical to MIH. It yields an informative description of the severity of MIH-affected teeth in terms of the stage of visible enamel destruction and the area of tooth surface affected (i.e. lesion clinical status and extent, respectively). In order to preserve the maximum amount of information from a clinical examination consistent with the need to permit direct comparisons between prevalence studies, two forms of the charting are proposed, a short form for simple screening surveys and a long form desirable for prospective, longitudinal observational research where aetiological factors in demarcated lesions are to be investigated in tandem with lesions distribution. Validation of the grading method is required, and its reliability and usefulness need to be tested in different age groups and different populations.

Molar-incisor hypomineralisation: a prevalence study amongst primary schoolchildren of Shiraz, Iran

AIM

To investigate the prevalence of molar-incisor hypomineralisation (MIH) amongst primary schoolchildren of Shiraz, Iran, taking into account the possible influence of biographic and socio-demographic parameters.

STUDY DESIGN AND METHODS

A randomised cluster sample of 9- to 11-year-old children (N = 810) had their first permanent molars and incisors (index teeth) evaluated using the European Academy of Paediatric Dentistry criteria for MIH. The examinations were conducted at schools by a calibrated examiner. Prevalence of MIH was assessed based on biographic and socio-demographic parameters including area of residency, school type, father's level of education, weight-for-age and height-for-age.

RESULTS AND STATISTICS

Of the children examined, 164/810 (20.2%) had MIH and 53.7% of them presented with MIH lesions in all first molars. Mild defects represented by demarcated yellow brown opacities comprised 35.5% of the total MIH lesions. The prevalence of MIH was significantly greater in girls, children with healthy body weight and height, those whose fathers did not have a tertiary education and from families of low socio-economic status. Regression analyses indicated that none of the biographic and socio-demographic variables represented a significant risk factor in the occurrence of MIH except for body weight. Obesity was negatively correlated to MIH (OR = 0.45; 95% CI 0.25-0.82).

CONCLUSIONS

The prevalence of MIH in a group of Iranian children was 20.2%. Biographic and socio-demographic parameters appeared to have no significant correlation with MIH except body weight, which warrants further research.

Risk factors in the occurrence of molar-incisor hypomineralization amongst a group of Iraqi children

BACKGROUND.  Despite the worldwide increasing interest in the prevalence studies of molar-incisor hypomineralization (MIH), there is still insufficient evidence to verify the aetiological factors of this condition. AIMS.  To investigate risk factors involved in the development of MIH in a group of school-aged Iraqi children. DESIGN.  Seven- to nine-year-old school children (823 of 1000 eligible, response rate of 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Mothers completed a medical history questionnaire-based interview performed in the schools by a trained examiner. RESULTS.  For children with MIH, 6% reported no relevant medical history; the remaining 94% reported various medical conditions putatively associated with MIH compared with 70% for the non-affected group. Post-natal medical conditions (33.3%) were most frequently reported. When data were split into the possible risk effect groups, maternal psychological stress (OR, 3.24), frequent exposure to ultrasonic scans during the last gestational trimester (OR, 2.51) and birth order as a fourth sibling or later (OR, 3.17 and 5.73, respectively) were previously unreported significant risk factors and postulated as contributing to, or causing the defect. CONCLUSIONS.  Children with MIH had experienced a greater number of medical conditions than their unaffected peers with no single health event identified as a risk factor.

Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children

BACKGROUND

Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce.

AIM

To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity.

DESIGN

A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist.

RESULTS

Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown.

CONCLUSIONS

The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.

Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren

BACKGROUND

The dynamic properties of molar-incisor-hypomineralisation lesions (MIH) may impact negatively on personal daily oral care resulting in increased treatment needs.

AIMS

To describe and compare individual oral health care practices between MIH-affected and non-affected children, to evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars, and to explore the role of reported fluoride exposure in the development of MIH.

STUDY DESIGN

A cluster sample of 7-9 year-old Iraqi schoolchildren (823 of 1000 eligible, response rate 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Of these 153 were diagnosed with the defect and were referred to as MIH-affected children.

METHODS

Mothers of the participating children were asked to complete an oral health-questionnaire administered at schools. This included questions regarding child's history of dental visits, fluoride intake and the pattern of oral hygiene practices. Assessment of the dental treatment requirements for the first permanent molars was performed in a sample subset drawn from a larger data set of affected children (n=100) having their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System. The sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars.

RESULTS

Of the total sample, approximately 71% of parents had taken their children to the dentist at some stage. For the total sample, tooth restoration or extraction was the most likely causes for seeking dental care at the first dental appointment (57.9%). Tap water was the main source of water consumed at home by the majority of children (77.8%). The prevalence of dental caries and tooth restorations was higher in hypomineralised affected molars (78.5%) than in the defect-free molars (33.7%).

STATISTICS

MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts (82.4%, 68.2%; respectively). They were over three times (OR = 3.18) more likely to visit the dentist complaining of pain and were over six times (OR = 6.37) more likely to seek dental care due to tooth sensitivity than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" was commonly reported in both groups (75.5%). Early exposure to fluoridated water appeared to have a protective effect for MIH (OR=0.38). Affected molars required more than twice the amount of restorative care than unaffected molars.

CONCLUSIONS

MIH did not seem to have an impact on the personal daily oral hygiene practices; however, MIH patients were commonly seeking dental consultation and needed care more often to improve their oral health.

Prevalence and characteristics of Molar Incisor Hypomineralisation (MIH) in the child population residing in Gandhinagar, Gujarat, India

Most prevalence studies on Molar Incisor Hypomineralisation (MIH) have been carried out in European countries and data from Asia especially south Asian populations are lacking.

AIM

To investigate the prevalence and clinical characteristics of MIH in children residing in a western region of India.

METHOD

A cross-sectional survey including 1,366 children from 5 age cohorts, 8-12 years, studying in primary schools or attending the University Department, was carried out in the area of Gandhinagar, Gujarat, India. The dental examination was performed by a single well-trained and calibrated examiner in day light conditions. Full mouth inspection of wet teeth was conducted using the EAPD 2003 criteria for diagnosis of MIH. Results were recorded and statistically analysed using Chi-square test, independent sample t-test and Pearson correlations.

RESULTS

Prevalence of MIH was 9.2% in the examined population. Males and females were equally affected. Among 12 index teeth involved in the examination, the most commonly affected were in descending order 46, 36, 16, 11 [FDI] and the least 42, 32, and 22. 17.4% of the cases revealed only molars involved, the remaining 72.6% having both molars and incisors affected; all four first permanent molars showed in 23% of the cases while no cases of only affected incisors were found. Of the MIH teeth 77.3% revealed mild defects and 22.7% severe defects. All incisors were mildly affected, as compared with only 67.1% of the molars, the remaining 32.9% being severely affected. As age increased, a statistically significant larger total number and severity level of affected teeth were recorded.

CONCLUSION

Prevalence of MIH using EAPD 2003 criteria was found to be similar to other studies evaluating children in different geographic locations such as Europe, South America etc. Using the EAPD standardised criteria, more studies should be conducted in other Indian regions, in order to further evaluate prevalence, characteristics and treatment needs for this clinically demanding condition.

Molar-incisor hypomineralisation: prevalence and defect characteristics in Iraqi children

BACKGROUND.  Little prevalence data relating to molar incisor hypomineralisation (MIH) exist for Middle East populations. AIM.  To evaluate the prevalence and the clinical features of MIH in school-aged children residing in Mosul City, Iraq. DESIGN.  A cluster sample of 823 7- to 9-year-old children had their first permanent molars and incisors (index teeth) evaluated using the European Academy of Paediatric Dentistry (EAPD) criteria for MIH. The examinations were conducted at schools by a calibrated examiner. RESULTS.  Of the children examined, 177 (21.5%) had hypomineralisation defects in at least one index tooth, 153 (18.6%) had at least one affected first molar or first molars and incisors and were considered as having MIH. The most commonly affected teeth were maxillary molars. Demarcated creamy white opacities were the most frequent lesion type. Dental restorations and tooth extraction because of MIH were uncommon. Children with three or more affected teeth were 3.7 times more likely to have enamel breakdown when compared with those children having only one or two affected teeth. CONCLUSIONS.  Molar incisor hypomineralisation was common amongst Iraqi children. Demarcated opacities were more prevalent than breakdown. The severity of the lesions increased with the number of affected teeth. The more severe the defect, the greater the involved tooth surface area.