Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil

PURPOSE

To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization.

METHODS

Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05).

RESULTS

513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01).

CONCLUSION

The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system

OBJECTIVES

To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system.

MATERIALS AND METHODS

Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained.

RESULTS

Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54).

CONCLUSION

Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration.

CLINICAL RELEVANCE

This study can provide information for decision-making.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Multi-scale characterization of Developmental Defects of Enamel and their clinical significance for diagnosis and treatment

Developmental Defects of Enamel (DDE) such as Dental Fluorosis (DF) and Molar Incisor Hypomineralization (MIH) are a major public health problem. Their clinical aspects are extremely variable, challenging their early and specific diagnosis and hindering progresses in restorative treatments. Here, a combination of macro-, micro- and nano-scale structural and chemical methods, including, among others, Atom Probe Tomography recently applied on tooth enamel, were used to study and compare MIH, DF and healthy teeth from 89 patients. Globally, we show that DF is characterized by an homogenous loss of mineral content and crystallinity mainly disrupting outside layer of enamel, whereas MIH is associated with localized defects in the depth of enamel where crystalline mineral particles are embedded in an organic phase. Only minor differences in elemental composition of the mineral phase could be detected at the nanoscale such as increased F and Fe content in both severe DDE. We demonstrate that an improved digital color measurement of clinical relevance can discriminate between DF and MIH lesions, both in mild and severe forms. Such discriminating ability was discussed in the light of enamel composition and structure, especially its microstructure, organics presence and metal content (Fe, Zn). Our results offer additional insights on DDE characterization and pathogenesis, highlight the potentiality of colorimetric measurements in their clinical diagnosis and provide leads to improve the performance of minimally invasive restorative strategies. STATEMENT OF SIGNIFICANCE: Developmental Defects of Enamel (DDE) are associated to caries and tooth loose affecting billions of people worldwide. Their precise characterization for adapted minimally invasive care with optimized materials is highly expected. Here In this study, first we propose the use of color parameters measured by a spectrophotometer as a means of differential clinical diagnosis. Second, we have used state-of-the-art techniques to systematically characterize the structure, chemical composition and mechanical optical properties of dental enamel teeth affected by two major DDE, Dental Fluorosis (DF) or Molar Incisor Hypomineralization (MIH). We evidence specific enamel structural and optical features for DF and MIH while chemical modifications of the mineral nanocrystals were mostly correlated with lesion severity. Our results pave the way of the concept of personalized dentistry. In the light of our results, we propose a new means of clinical diagnosis for an adapted and improved restoration protocol for these patients.

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.

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

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

Clinical evaluation of giomer- and resin-based fissure sealants on permanent molars affected by molar-incisor hypomineralization: a randomized clinical trial

BACKGROUND

Molar-incisor hypomineralization (MIH) is a common condition among children that significantly increases the risk of caries. The objective of this research was to evaluate the clinical success of giomer- and conventional resin-based sealants applied on first permanent molars (FPMs) affected by MIH.

METHODS

One-hundred FPMs with MIH which were indicated for non-invasive fissure sealant were selected in 39 children, aged 6-12 years. Using a split mouth design, the FPMs were randomized into two groups; Group 1. Resin sealant (etch-and-rinse + Conceal F) and Group 2. Giomer sealant (self-etch primer + BeautiSealant). Clinical evaluation was performed using the modified United States Public Health Service (USPHS) criteria at 1, 3, 6 and 12 months. The Log-rank, Fisher's exact test and Kaplan-Meier analysis were used for statistical analysis.

RESULTS

At 12 months, the retention rates in Group 1 and Group 2 were 68% and %8, respectively (p = 0.000). The cumulative survival rates of conventional resin sealants were significantly higher than giomer sealants for all follow-up visits (p < 0.05). In Groups 1 and 2, the distribution of unsuccessful sealants on mandibular vs maxillary FPMs were 32.1% vs 31.8% (p = 0.612) and 91.7% vs 92.3% (p = 0.664), respectively. Although the success rate was higher for teeth with white opacities or lesions with less extension in Group 1, no significant difference was found. The average survival time was found as 10.46 ± 3.21 months in Group 1 and 4.02 ± 4.43 months in Group 2.

CONCLUSIONS

The conventional resin-based sealants yielded a better clinical performance over the 12-month evaluation period than the giomer sealants which were applied with self-etch primer. The high failure rate observed in giomer sealants could be explained by the possible deficiency in the etching capacity of self-etch primer on MIH-affected teeth. Trial registration ClinicalTrials.gov, NCT04929782. Registered 10 June 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04929782 .

Molar-incisor hypomineralization and dental caries: A hierarchical approach in a populational-based study

The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH) studies. Hypomineralized defects can have several consequences such as hypersensitivity, increased dental plaque accumulation, and consequently higher caries risk. This cross-sectional study aimed to investigate the prevalence of MIH and its association with dental caries in schoolchildren from a city in southern Brazil. A random cluster sample of schoolchildren was selected. Clinical examinations were carried out to collect information on MIH (following the European Academy of Pediatric Dentistry criteria), dental caries (using the DMF-T index) and gingivitis. Socioeconomic, demographic and behavior variables were collected using a standardized questionnaire answered by the children's parents/caregivers. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance through a hierarchical approach (p<0.05). A total of 513 schoolchildren were included in the study. MIH and caries prevalence was 19.7% and 31.6%, respectively. The mean age was 11.6 (+1.9) years. Dental caries was more prevalent in children with MIH (PR 1.39; 95% CI 1.05 - 1.85). Older children and children whose families were enrolled in conditional cash transference programs (PR 1.97 95% CI 1.47 - 2.64), and children who did not have their mother or father as the head of the family (PR 1.56 95% CI 1.06 - 2.30) presented a higher prevalence of dental caries. Our findings suggest that children with MIH are more likely to have dental caries.

Effects of different remineralization agents on MIH defects: a randomized clinical study

OBJECTIVES

The aim of this study was to present a comparative evaluation of the long-term efficacy of fluoride varnish and pastes containing CPP-ACP and CPP-ACP with fluoride (CPP-ACFP) in the remineralization of creamy-white and yellow-brown defects in permanent first molars with MIH.

MATERIALS AND METHODS

The study included 120 teeth with yellow-brown or creamy-white defects in 67 children (37 girls, 30 boys) aged 6-9 years (mean, 7.2) who were newly diagnosed with MIH with no substance loss or caries or prior restorative treatment. The patients were randomly divided into the experiment groups; control (oral hygiene motivation only), fluoride varnish, and pastes containing CPP-ACP and CPP-ACPF, and followed up for 24 months. The evaluations were made based on the ICDAS criteria and the measurements which were performed using the laser fluorescence method (DIAGNOdent, KaVo, Biberach, Germany) in the follow-ups.

RESULTS

The research was completed with 49 patients (23 females, 26 males; mean age, 7.7) and 90 teeth. All remineralization agents increased remineralization rates in both creamy-white and yellow-brown colored defects without presenting any statistically significant difference at the end of the follow-up period (p > 0.05). However, the effects of fluoride varnishes were late to observe when compared to pastes containing CPP-ACP and CPP-ACPF.

CONCLUSIONS

Pastes containing calcium and phosphate may be recommended for the longer-term preservation of teeth with yellow-brown defects which showed a post-eruptive breakdown in a shorter time.

CLINICAL RELEVANCE

There is a lack of studies investigating MIH treatments in which lesion appearance was recorded. This study evaluated creamy-white and yellow-brown MIH defects separately and reported long-term results of different remineralization agents.

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Objective:

This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren.

Methodology:

Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis.

Results:

The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth.

Conclusions:

No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars.

Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization-related enamel breakdown-A retrospective cohort study

BACKGROUND

There is little information available on the longevity of non-invasive glass ionomer cement (GIC) and composite restorations as well as conventional composite and ceramic restorations placed on permanent teeth with enamel breakdowns due to molar-incisor hypomineralization (MIH).

AIM

To compare the longevity of the abovementioned treatment procedures.

DESIGN

Of 377 identified MIH patients, 118 individuals received restorative treatment and were invited for clinical examination, including caries and MIH status. Finally, survival data from 204 MIH-related restorations placed on 127 teeth were retrospectively collected from 52 children, monitored between 2010 and 2018. Descriptive and explorative analyses were performed, including Kaplan-Meier estimators and the Cox regression model.

RESULTS

The mean patient observation time was 42.9 months (SD = 35.1). The cumulative survival probabilities after 36 months-7.0% (GIC, N = 28), 29.9% (non-invasive composite restoration, N = 126), 76.2% (conventional composite restoration, N = 27) and 100.0% (ceramic restoration, N = 23)-differed significantly in the regression analysis.

CONCLUSIONS

Conventional restorations were associated with moderate-to-high survival rates in MIH teeth. In contrast, non-invasive composite restorations, which were predominately used in younger or less cooperative children, were linked to lower survival rates.

Aesthetic perception in children with molar incisor hypomineralization

PURPOSE

To investigate the relationship between aesthetic perception and molar incisor hypomineralization (MIH) in schoolchildren aged 8-12 years.

METHODS

The study included 467 pupils enrolled in elementary schools. Once authorization was received, the students were examined for DMFT and dmft indexes (WHO criteria), and for MIH (EAPD criteria). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA), a questionnaire divided into several items, including physical, psychological and social domains; perception about tooth pleasantness, tooth alignment, tooth discoloration and tooth health; and reported pleasant colour. Data analysis was carried out using descriptive statistics, the Chi-square, the Mann-Whitney and the Kruskal-Wallis tests, and linear regression at a significance level of 0.05.

RESULTS

The tooth health perception was worse when the child had MIH, and the tooth alignment and tooth discoloration perceptions, when MIH affected the incisors. The number of teeth affected by MIH was associated with higher averages in the tooth discoloration perception.

CONCLUSIONS

Children with MIH showed more negative perceptions toward tooth health, tooth alignment and tooth discoloration. However, none of the clinically investigated variables negatively impacted the reported pleasant colour question.

Association of High-Dose Vitamin D Supplementation During Pregnancy With the Risk of Enamel Defects in Offspring: A 6-Year Follow-up of a Randomized Clinical Trial

IMPORTANCE

Enamel defects of developmental origin affect up to 38% of schoolchildren and is recognized as a global public health challenge. The impaired enamel formation results in pain owing to hypersensitivity, posteruptive breakdowns, rapid caries progression, and extractions in some cases. The etiology is unknown; therefore, prevention is currently not possible.

OBJECTIVE

To assess the association of a high-dose vitamin D supplementation in pregnant women with enamel defects and caries in their offspring.

DESIGN, SETTING, AND PARTICIPANTS

Post hoc analysis of a double-blind, single-center, randomized clinical trial, the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort (COPSAC2010). Enrollment began March 2009 and included 623 women recruited at 24 weeks of pregnancy and 588 of their children. A dental examination was completed at age 6 years in 496 of 588 children (84%). Data were analyzed in 2018.

INTERVENTION

High-dose vitamin D3 (2400 IU/d; N = 315) or matching placebo tablets (N = 308) from pregnancy week 24 to 1 week post partum. In addition, all women received 400 IU/d of vitamin D3 as part of standard care.

MAIN OUTCOMES AND MEASURES

Enamel defect was defined as having at least 1 molar affected by demarcated opacity, enamel breakdown, and/or atypical restoration. Caries was defined as decayed, missing, or filled surfaces in both the deciduous and permanent dentitions (World Health Organization standard).

RESULTS

The risk of enamel defects in the permanent dentition was lower in the offspring of mothers who received high-dose vitamin D supplementation during pregnancy compared with standard dose (15.1% [n = 26 of 172] vs 27.5% [n = 44 of 160]; odds ratio, 0.47; 95% CI, 0.27-0.81). A similar association was observed for the deciduous dentition (8.6% [n = 21 of 244] vs 15.9% [n = 40 of 252]; odds ratio, 0.50; 95% CI, 0.28-0.87). There was no association between supplementation and caries.

CONCLUSIONS AND RELEVANCE

High-dose vitamin D supplementation during pregnancy was associated with approximately 50% reduced odds of enamel defects in the offspring. This suggests prenatal vitamin D supplementation as a preventive intervention for enamel defects, with a clinically important association with dental health.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00856947.

Prevalence of Hypersensitivity in Teeth Affected by Molar-Incisor Hypomineralization (MIH)

AIM

This study aimed to investigate the prevalence of hypersensitivity in molar-incisor hypomineralization (MIH)-affected molars through a census carried out in 8-year-old schoolchildren.

METHODS

Examinations were conducted by a calibrated examiner, using the Nyvad criteria for caries diagnosis and a new criterion for MIH assessment. For hypersensitivity assessment, all MIH-affected molars were included. Nonaffected molars from the same child were used as controls. Air blast reaction was measured using the Visual Analogue Scale (VAS) and the Schiff Cold Air Sensitivity Scale (SCASS) scale, while tactile hypersensitivity was scored using VAS only. Statistical analysis was performed using the Kruskal-Wallis test followed by Dunn's multiple comparisons test for quantitative data. χ2 was used for the comparison of categorical data.

RESULTS

In total, 631 children were assessed, of whom 102 had MIH-affected molars (16.1%). Of these, 51.7 and 8.7% presented enamel and dentin carious lesions, respectively. Regarding the number of teeth, 239 molars were MIH affected (59.8%), with 188 (78.7%) being classified as mild (opacities only), 20 (8.4%) as moderate (posteruptive enamel breakdown), and 31 (13%) as severe (posteruptive breakdown involving dentin/atypical restorations). Hypersensitivity was recorded in only one control molar, while the prevalence of hypersensitivity in MIH-affected molars was 34.7%, being of low intensity and more prevalent in moderate (55%) and severe cases (51.6 %) than in mild cases (29.8%, p = 0.008). An association between hypersensitivity and the presence of mild and moderate cases was observed. Although the same association was observed for severe cases, it was not considered a reliable information as 90% of the MIH-affected molars with posteruptive breakdown involving dentin were affected by carious lesions. It is known that dental caries is a confounding factor for the presence of hypersensitivity.

CONCLUSIONS

Hypersensitivity was significantly higher in MIH-affected molars than in nonaffected molars, being associated with MIH teeth presenting opacities and posteruptive enamel breakdown.

The Burden and Management of Dental Caries in Older Children

Dental caries is endemic in children and adolescents and has significant morbidity. This complex and chronic disease has both genetic and environmental etiologic factors. In children the preponderance of caries affects tooth surfaces with pits and fissures despite these representing only a small portion of the tooth surfaces that are at risk. Pit and fissure sealants are effective in preventing and managing noncavitated caries lesions in these surfaces. A variety of materials are clinically effective, and health care guidelines recommend the use of pit and fissure sealants as part of a comprehensive dental caries prevention program.

The Association between Molar-Incisor Hypomineralization and Dental Caries with Socioeconomic Status as an Explanatory Variable in a Group of Finnish Children

The aim of this study was to investigate if a developmental enamel defect known as Molar-Incisor Hypomineralization (MIH) is associated with dental caries. Socioeconomic status (SES) was examined as a confounding factor between caries and MIH. In this cross-sectional study, 636 children, aged 8 to 13 years, from three towns (two rural areas and one urban area) in Finland were examined for MIH in line with the criteria of the European Academy of Paediatric Dentistry. Caries status for permanent teeth was recorded as decayed, missing and filled teeth (DMFT). Caries experience (DMFT > 0) in the first permanent molars (FPMs) was set as an outcome. SES was determined using a questionnaire completed by parents. The prevalence of MIH was 18.1%. The mean DMFT in FPMs for children with MIH was higher than for their peers, 1.03 ± 1.25 vs. 0.32 ± 0.80 (p = 0.000, Mann-Whitney U test). In a multivariate analysis using the generalized linear mixed model where locality, SES, age and MIH were taken into account as caries risk indicators, MIH was the strongest risk indicator of caries in FPMs (Odds Ratio: 6.60, 95% Confidence Interval: 3.83–11.39, p = 0.000). According to the study results, children with MIH have a higher risk for dental caries than children without MIH.

Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model

Background

This study aimed to evaluate the survival rate of glass hybrid restorations placed under the atraumatic restorative treatment (ART) technique in first permanent molars affected by molar incisor hypomineralization (MIH).

Methods

Sixty teeth with severe MIH associated to carious dentin lesions without pulp involvement were included. Treatments were performed by one trained dentist using the ART approach and restored with a glass hybrid restorative system (Equia Forte, GC®) on school premises. Treatments were evaluated after 6 and 12 months by an independent examiner using the modified ART criterion. Data analysis involved descriptive statistics and actuarial success analysis.

Results

The sample comprised 24 (54.54%) girls and 20 (45.45%) boys with a mean age of 10.55 (±1.25) years. In regard to the number of surfaces involved in the restorations, 29 (48.3%) comprised one surface and 31 (51.7%) two or more surfaces. Considering cavity extent, 25 (41%) presented dentin cavitation without cusp weakness, 23 (37.7%) with large dentin cavitation with cusp weakness and 13 (21.3%) with large dentin cavitation with the breakdown of one or more cusps. Only 4 teeth required local anesthesia. A success rate of 98.3% after 6 and 12 months was observed, as only one restoration failed. The only failure occurred in a restoration involving three or more sur-faces presenting the breakdown of all cusps.

Conclusion

Restorations using a glass hybrid restorative system and performed in the field with the ART technique proved, after 12 months of evaluation, to be an effective approach to preserving first permanent molars affected by MIH.

Trial registration

REBEC-RBR-8drccq (17/06/15).

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0528-0) contains supplementary material, which is available to authorized users.