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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.

Update of the molar incisor hypomineralization: Würzburg concept

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Is there an association between molar incisor hypomineralization and developmental dental anomalies? A case-control study

BACKGROUND

The aim of this study was to determine whether there is any association between molar incisor hypomineralization and developmental dental anomalies.

METHODS

Two pediatric dentists evaluated panoramic radiographs of 429 children aged 8-14 years with molar incisor hypomineralization (study group) and 437 children without molar incisor hypomineralization (control group) in terms of developmental dental anomalies. Twelve different developmental dental anomalies were categorized into four types: size (microdontia, macrodontia); position (ectopic eruption of maxillary permanent first molars, infraocclusion of primary molars); shape (fusion, gemination, dilaceration, taurodontism, peg-shaped maxillary lateral incisors); and number (hypodontia, oligodontia, hyperdontia) anomalies.

RESULTS

No significant difference was observed in the frequencies of developmental dental anomalies between the study and control groups in total, females, and males (p > 0.05). A statistically significant difference was found between the distribution of developmental size, position, shape, and number anomalies between the study and control groups (p = 0.024). The most common anomaly in both groups was hypodontia (6.3% and 5.9%, respectively). There was a significant difference between the study and control groups in terms of subtypes of shape anomaly in all children and females (p = 0.045 and p = 0.05, respectively).

CONCLUSIONS

While a significant difference was observed between the distributions of types of developmental dental anomalies between individuals with and without molar incisor hypomineralization, there was no difference in terms of the frequency of developmental dental anomalies.

Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren

PURPOSE

Data about molar-incisor hypomineralization (MIH) prevalence and its severity remains limited for some Latin American countries. Furthermore, its association with socioeconomic status (SES) is still unclear. Thus, this study aims to determine the prevalence and severity of MIH in Santiago, Chile and explore its association with SES.

METHODS

A cross-sectional study with schoolchildren between 6 and 12 years was conducted. Children were evaluated using the European Academy of Paediatric Dentistry to diagnose MIH, and the Mathu-Muju and Wright criteria to determine its severity.

RESULTS

A total of 1,270 children were included. The MIH prevalence was 12.8% without association with gender (p = 0.609). Prevalence was higher among schoolchildren ages 8 and 9 (p = 0.002), and in lower SES (p = 0.007). MIH mild cases were the most prevalent (63%), and severity was not related to gender (p = 0.656), age (p = 0.060), or SES (p = 0.174).

CONCLUSIONS

The prevalence of MIH in the province of Santiago, Chile is 12.8% and was found to have a higher incidence in 8-9-year-old students and among those categorized by low SES. Furthermore, MIH prevalence was associated with low SES.

IMPLICATIONS

Public health policies to address MIH in Chile should start with schoolchildren aged 8 to 9, and with low SES.

Do hypomineralized teeth affect parents' emotional states and attitudes more than other discoloration conditions?

Discoloration poses a significant esthetic issue, and parents' opinions and emotional states may vary regarding different types of discoloration, such as molar incisor hypomineralization, caries or chromogenic bacteria. This study aimed to assess parent's emotional state and attitudes towards discoloration in primary and permanent teeth. A two-part questionnaire was designed, consisting of questions about demographic data and simulated visuals of different primary and permanent teeth discoloration conditions. The Visual Analog Scale (VAS) was used to determine the emotional state, while parents' attitudes towards dental consultation for each simulated visual were determined using statements such as "Absolutely yes"; "Yes"; "I don't have an idea"; "No"; "Absolutely no". The simulated visuals included cases of "caries with cavitation", "yellow-brown hypomineralized area", "white hypomineralized area" and "chromogenic bacteria". The questionnaire was distributed to 300 parents through online communication channels. Categorical variables were analyzed using Pearson chi-square, with statistical significance set as p < 0.05. A total of 230 parents completed the questionnaire. The highest VAS scores and the highest percentage of "Absolutely yes" responses were observed for "caries with cavitation" in both primary (77.8%, 81.7%) and permanent (60.4%, 94.3%) teeth. Additionally, statistically significant differences were found in the VAS scores for chromogenic bacteria (p = 0.04), caries with cavitation (p = 0.005), white hypomineralized area (p = 0.01) and yellow-brown hypomineralized area (p = 0.02). Comparatively, parental preferences showed statistically significant differences for chromogenic bacteria (p = 0.01), caries with cavitation (p = 0.01), yellow-brown hypomineralized area (p = 0.01) and white hypomineralized area (p = 0.004). Parents displayed stronger emotional responses towards "caries with cavitation" compared to hypomineralization and chromogenic bacteria discolorations and expressed a positive attitude towards seeking dental consultation.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10 years old children: A systematic review and meta-analysis

OBJECTIVES

This study aimed to evaluate the impact of molar incisor hypomineralization (MIH) and its different severities on various aspects of oral health-related quality of life (OHRQoL) in children between 8 and 10 years of age.

DATA SOURCES

The search terms were chosen according to the Medical Subject Headings (MeSH) and non-MeSH. Potentially eligible studies involved the OHRQoL evaluation in 8-10 years old children with MIH. An electronic search of published studies was carried out in August 2022 on Scopus, Web of Science, and PubMed databases. Of 130 papers retrieved initially, 21 were eligible to be included in the systematic review, of which 8 were excluded. The OHRQoL questionnaires used in the studies included Caregivers Perceptions Questionnaire (CPQ) 8-10, Child Oral Health Impact Profile questionnaire, and Child Oral Impacts on Daily Performances questionnaire. Nine studies using CPQ8-10 contributed to the meta-analysis.

RESULTS

According to meta-analysis, the results revealed that in MIH children a significant increase was observed in the total score of CPQ 810 with the pooled mean of 15.89 (95% confidence interval [CI]:8.95-22.84; P-value = .001) and in oral symptoms, functional limitation and emotional well-being domains with the pooled means of 6.25 (95% CI:4.01-8.50; P-value = .001), 3.88 (95% CI:1.93-5.83; P-value = 0.001), and 3.24 (95% CI:0.96-5.52; P-value = .01), respectively. While the increase in social well-being with the pooled mean of 1.65 (95% CI: -0.47 to 3.76; P-value = .13) was not significant. Subgroup analysis based on MIH severity showed no significant difference in OHRQoL means for all variables.

CONCLUSION

Suffering from MIH, negatively affected the total score and all domains of the CPQ 8-10 questionnaire, except for social well-being. Furthermore, different severities of MIH had no significant impact on OHRQoL in children.

Prenatal exposure to persistent organic pollutants and molar-incisor hypomineralization among 12-year-old children in the French mother-child cohort PELAGIE

BACKGROUND

Exceptional episodes of exposure to high levels of persistent organic pollutants have already been associated with developmental defects of enamel among children, but knowledge is still scarce concerning the contribution of background levels of environmental contamination.

METHODS

Children of the French PELAGIE mother-child cohort were followed from birth, with collection of medical data and cord blood samples that were used to measure polychlorinated biphenyls (PCBs), organochlorine pesticides (OCs), and perfluorinated alkyl substances (PFASs). At 12 years of age, molar-incisor hypomineralization (MIH) and other enamel defects (EDs) were recorded for 498 children. Associations were studied using logistic regression models adjusted for potential prenatal confounders.

RESULTS

An increasing log-concentration of β-HCH was associated with a reduced risk of MIH and EDs (OR = 0.55; 95% CI, 0.32-0.95, and OR = 0.65; 95% CI, 0.43-0.98, respectively). Among girls, intermediate levels of p,p'-DDE were associated with a reduced risk of MIH. Among boys, we observed an increased risk of EDs in association with intermediate levels of PCB 138, PCB 153, PCB 187, and an increased risk of MIH with intermediate levels of PFOA and PFOS.

CONCLUSIONS

Two OCs were associated with a reduced risk of dental defects, whereas the associations between PCBs and PFASs and EDs or MIH were generally close to null or sex-specific, with an increased risk of dental defects in boys. These results suggest that POPs could impact amelogenesis. Replication of this study is required and the possible underlying mechanisms need to be explored.

Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces

BACKGROUND

Resin infiltration is a micro-invasive treatment for molar incisor hypomineralisation (MIH). In this study it was aimed to evaluate the masking effect of resin infiltration treatment (ICON) on hypomineralised enamel surface of permanent anterior teeth by using laser fluorescence, spectrophotometer, and cross-polarisation photography.

METHODS

A total of 116 permanent central incisors in 37 patients were included in the study. The resin infiltration treatment (Icon®) was applied to the teeth with MIH; the healthy teeth received no treatment (control). Hypomineralised enamel lesions were evaluated by ICDAS II criteria. DIAGNOdent Pen was used to assess the lesions and healthy enamel surface quantitatively. Colour changes in enamel lesions were evaluated by using a spectrophotometer (VITA EasyShare). Each enamel lesion was imaged using a cross-polarization technique before and after treatment. All photos were assessed using Image J to evaluate the changes in lesion size. Enamel lesions were evaluated before; immediately after; 1; 3; and 6 months after treatment. Statistical significance was set as p < 0.05.

RESULTS

After the resin infiltration, significant decreases were found in the mean DIAGNOdent values for the treatment group (p < 0.05). The colour differences before and after treatment significantly differed in all follow-ups (p < 0.05). In the treatment group, lesion areas decreased significantly after treatment (p < 0.05).

CONCLUSIONS

The resin infiltration treatment has a masking effect on MIH lesions without cavities, with stable outcomes after six months. The cross-polarization photography technique may be use to evaluate the lesion size instead of photography with flash.

TRIAL REGISTRATION

NCT04685889 (registered 28 December 2020).

Prevalence, Severity and Associated Risk Indicators of Molar Incisor Hypomineralization amongst 8-13-year-old Children of Vadodara District Gujarat: A Cross-sectional Study

Context

Molar incisor hypomineralization (MIH) is an emerging clinical problem as the affected tooth is prone to dental caries with the lapse of time.

Aims

To assess the prevalence, severity, and associated risk indicators of MIH amongst 8-13 years of children of Vadodara District, Gujarat, India.

Materials and methods

A cross-sectional study with a sample size of 3,000 government schoolchildren. A total of 1,500 children each from urban and rural areas were randomly selected and examined. Only permanent incisors and first molars were examined. MIH was diagnosed clinically based on the diagnostic criteria established by the European Academy of Paediatric Dentistry (EAPD), 2003. To check the relation between the two variables-Pearson's chi-squared test was applied. Fisher's exact test was applied when less than five expected values were found.

Results

A total of 286 children (9.6 %) had MIH, with 189 (rural) and 97 (urban) children. MIH was significantly higher in the rural population as compared to the urban. In the rural area, the cause was found to be a child suffering from an illness (>15 days) which was 35.98%, and in the urban area was due to prolonged use of antibiotics before 4 years of age, which was 28.87%.

Conclusion

The overall prevalence rate of MIH among the screened children between the age-group 8 and 13 was found to be 9.6%. Males were more affected. The severity of MIH was more in molars compared to incisors and more in children of rural areas.

Clinical significance

Protocol for early diagnosis and follow-up to access the squeal of breakdown should be undertaken along with parents and health workers.

How to cite this article

Shah VU, Dave BH, Chari DN, et al. Prevalence, Severity and Associated Risk Indicators of Molar Incisor Hypomineralization amongst 8-13-year-old Children of Vadodara District Gujarat: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):280-286.

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

Objectives

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Artificial intelligence system for training diagnosis and differentiation with molar incisor hypomineralization (MIH) and similar pathologies

OBJECTIVES

Molar incisor hypomineralization (MIH) is a difficult-to-diagnose developmental disorder of the teeth, mainly in children and adolescents. Due to the young age of the patients, problems typically occur with the diagnosis of MIH. The aim of the present technical note was to investigate whether a successful application of a neural network for diagnosis of MIH and other different pathologies in dentistry is still feasible.

MATERIALS AND METHODS

For this study, clinical pictures of four different pathologies were collected (n = 462). These pictures were categorized in caries (n = 118), MIH (n = 115), amelogenesis imperfecta (n = 112) and dental fluorosis (n = 117). The pictures were anonymized and a specialized dentist taking into account all clinical data did the diagnosis. Then, well-investigated picture classifier neural networks were selected. All of these were convolutional neural networks (ResNet34, ResNet50, AlexNet, VGG16 and DenseNet121). The neural networks were pre-trained and transfer learning was performed on the given datasets.

RESULTS

For the vgg16 network, the precision is the lowest with 83.98% as for the dense121 it shows the highest values with 92.86%. Comparing the different pathologies between the investigated neural networks, there is no trend detectable.

CONCLUSION

In the long term, an implementation of artificial intelligence for the detection of specific dental pathologies is conceivable and sensible.

CLINICAL RELEVANCE

Finally, this application can be integrated in the area of training and teaching in order to teach dental students as well as general practitioners for MIH and similar dental pathologies.

Correlation between Aerosol Therapy and Other Associated Factors in Early Childhood with Molar Incisor Hypomineralization

Context

The etiology of molar incisor hypomineralization (MIH) has been extensively explored. Recently, the effect of drugs used in aerosol therapy in childhood has been implicated as a possible factor in the development of MIH.

Aim

A case-control study was conducted in children aged 6-13 years to determine the association between aerosol therapy and other factors in the development of MIH.

Materials and methods

A total of 200 children were examined for the presence of MIH according to the European Academy of Paediatric Dentistry (EAPD) criteria (2003). Their mothers or primary caregivers were interviewed regarding the preterm history and perinatal, and postnatal history of the child up to 3 years of life.

Statistical analysis

The collected data were subjected to statistical analysis using descriptive and inferential analyses. The p-value ≤ 0.05 was considered statistically significant.

Results

Statistically significant association was observed between the development of MIH and exposure to aerosol therapy in childhood and the use of antibiotics before 1 year of life.

Conclusion

Exposure to aerosol therapy and antibiotics before 1 year of age are risk factors in MIH. Children who had aerosol therapy and antibiotics are 2.01 times and 1.61 times more prone to MIH.

How to cite this article

Shinde MR, Winnier JJ. Correlation between Aerosol Therapy and Other Associated Factors in Early Childhood with Molar Incisor Hypomineralization. Int J Clin Pediatr Dent 2022;15(5):554-557.

"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.

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 .

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.

Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial

OBJECTIVES

The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively.

METHODS

Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis.

RESULTS

In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01).

CONCLUSION

Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes.

CLINICAL SIGNIFICANCE

Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors.

Are yellow-brownish opacities in hypomineralized teeth more prone to breakage than white-creamy ones? A systematic review

OBJETIVE

To evaluate all the available evidence assessing if in hypomineralized teeth, yellow-brownish opacities are more prone to post-eruptive breakdown (PEB) compared to white-creamy opacities.

MATERIALS AND METHODS

Observational studies that evaluated the occurrence of PEB in hypomineralized teeth were considered for inclusion. Electronic searches were performed up to January 2022 in MedLine, LILACS, BBO, Cochrane Library, Web of Science, Scopus, and EMBASE. Neither publication date nor language restrictions were imposed to the searches. Two researchers independently performed the study selection, data extraction, and quality assessment of the included studies according to the Newcastle-Ottawa Scale (NOS). Datasets from studies were grouped for narrative synthesis based on the severity of the PEB (enamel or dentin), type of tooth (molar or incisor), unit of analysis (subject or tooth or tooth surface), and follow-up period (in months). The certainty of evidence was evaluated using the GRADE approach.

RESULTS

Nine studies were included, five cohort and three cross-sectional. All studies assessed the opacities and PEB by visual examination and diagnosed MIH according to EAPD criteria. In the cohort studies, considering all follow-up periods (ranging from 6 to 36 months), dark opacities fractured more than light opacities, at both enamel and enamel/dentin levels, and molars fractured more than incisors. In two out of three cross-sectional studies, dark opacities also fractured more than light opacities, but the deep of the PEB (enamel or dentin breakdown) or the type of tooth (molar or incisor) was not considered in the analysis.

CONCLUSION

Although it seems plausible to state that darker demarcated opacities in MIH patients broke more often than light ones, based on this systematic review of the literature, the certainty of the available evidence about this association is still very low.

CLINICAL RELEVANCE

More reliable and valid research is still necessary to support any future recommendation that MIH children who present yellow-brownish opacities should be monitored at shorter intervals compared to those who present only white-creamy opacities.

Effect of Remineralization Agents on Molar-Incisor Hypomineralization-Affected Incisors: A Randomized Controlled Clinical Trial

OBJECTIVE

The objective of this study was to evaluate the remineralization effect of two different mineral containing agents on white/creamy and yellow/brown demarcated opacities in incisors in children with molar-incisor hypomineralization (MIH) by using laser fluoresence (LF).

STUDY DESIGN

Fifty-three children (n=401 lesions) with MIH were randomly divided into three groups: (1)calcium glycerophosphate (CaGP), (2)casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and, (3)control (1450 ppm fluoride toothpaste). Remineralization was evaluated by means of LF, at baseline, after one and threemonths. Anova Test for Repeated Measurements in intra-group comparisons in evaluating the effectiveness of remineralization agents. One-way Variance Analysis (ANOVA) and Tukey-Kramer Multiple Comparison test were used in the comparisons between groups and, Student Newman Keuls Multpile Comparison Test was used to determine the differences between the measurement averages in case of p<0.05.

RESULTS

There was a significant improvement in MIH-lesions over time in all groups (p<0.001), with no differences between groups. The highest percentage of change was observed in CPP-ACFP in lesions LF≤20 scores and the mean percentage of change LF>20 scores, the highest percentage changes in CaGP. There was no significant difference between the groups over the time for all the used outcome measures (p>0.05).

CONCLUSION

The additional use of both mineral containing agents in MIH-affected teeth improved these hypomineralized lesions with mineral deposition. Even if both agents could be used in the hypomineralized teeth with demarcated opacities, future studies are recommended the long-term effect of these mineral containing agents with longer observation and a larger sample size.

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.

Association Between Molar-Incisor Hypomineralization and Enamel Hypoplasia

OBJECTIVE

To investigate the association between molar-incisor hypomineralization (MIH) and enamel hypoplasia.

STUDY DESIGN

The sample consisted of 311 orthodontic files of patients aged between 12 and 18 years, divided into two groups: patients with MIH (109) and without MIH (202). MIH and enamel hypoplasia were diagnosed via panoramic radiographs and intraoral photographs, followed by clinical examination of the MIH-affected patients as per the modified EAPD scoring criteria. Chi-square test and t test were used to assess intergroup comparisons regarding sex, age and race. Fisher's Exact test was used to compare the groups regarding the presence of enamel hypoplasia and the Adjusted Odds Ratios (OR) were calculated.

RESULTS

There was an association between MIH and enamel hypoplasia. The prevalence of enamel hypoplasia (5.5%) was significantly higher in patients with MIH compared to the control group (0.49%). MIH lesions increase 12.45-fold the risk of having enamel hypoplasia.

CONCLUSION

Patients with MIH have a higher prevalence of enamel hypoplasia and these defects seem to share the same etiological factor.

The association between molar incisor hypomineralization and oral health-related quality of life: a cross-sectional study

Objectives

We aimed to assess the association between molar incisor hypomineralization (MIH) and the oral health-related quality of life (OHRQoL) in a group of 7- to 14-year-old children in Berlin, Germany.

Materials and methods

The cross-sectional study consisted of a consecutive sample of 317 children, aged 7–14 years (49% girls, 51% boys; mean age, 8.71). Data were collected between June 2018 and December 2019. MIH was diagnosed using the criteria of the European Academy of Paediatric Dentistry. OHRQoL was assessed using the German 19-item version of the Child Oral Health Impact Profile (COHIP-G19). Differences in COHIP-19 summary scores between controls without MIH and MIH patients and with regards to MIH severity were tested for statistical significance using t test and analysis of variance (ANOVA), respectively.

Results

Data were obtained for 217 untreated MIH patients and 100 controls. OHRQoL of MIH patients was significantly more impaired than of controls indicated by COHIP-19 mean scores (60.9 ± 10.7 vs. 67.9 ± 7.8; p < 0.001). Patients with severe MIH (59.6 ± 11.0) reported significantly worse OHRQoL than patients with mild MIH (63.6 ± 9.1; p = 0.013).

Conclusions

MIH has a significant negative impact on the children’s OHRQoL. Patients with severe MIH experience a greater negative impact on OHRQoL than those diagnosed with mild MIH.

Clinical significance

MIH is one of the major dental problems of our time; pediatric dentists should be aware of its impact on the OHRQoL of the patient.

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.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial

Objectives

This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).

Methods

One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher’s exact test, Kaplan–Meier analysis, Mann–Whitney U test, and Friedman test.

Results

Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.

Conclusions

In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.

Clinical Significance

Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.

Trial registration

Clinical Trials Registration Number: NCT03862014.

Molar Incisor Hypomineralization Prevalence in the Schoolchildren of Gannavaram Mandal, Krishna District, Andhra Pradesh, India: A Cross-sectional Study

AIM AND OBJECTIVES

To evaluate the prevalence of molar incisor hypomineralization (MIH) in schoolchildren of the ages between 8 and 14 years of Gannavaram Mandal, Krishna district, Andhra Pradesh, India.

MATERIALS AND METHODS

A total of 2,250 children of ages between 8 and 14 years were selected randomly from different schools. After obtaining requisite permissions from Mandal Educational Officer (MEO), children was screened for the prevalence of MIH according to European Academy of Paediatric Dentistry (EAPD) 2003 diagnostic criteria and severity for MIH was examined using Wetzel and Reckel scale.

RESULTS

Prevalence of MIH was observed to be 2.1% with higher cases of mild severity and with no sex predilection (p > 0.05).

CONCLUSION

Early diagnosis and treatment can significantly reduce complications associated with MIH. Very few studies have been conducted in India and studies encompassing extensive population are warranted to better understand its etiology.

CLINICAL SIGNIFICANCE

MIH lesions lead to carious development. Hence there is need to identify MIH in children as early as possible to reduce the clinical complications.

HOW TO CITE THIS ARTICLE

Tarannum, Ravichandra KS, Muppa R, et al. Molar Incisor Hypomineralization Prevalence in the Schoolchildren of Gannavaram Mandal, Krishna District, Andhra Pradesh, India: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(6):737-740.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10-year-old children

Objectives

The aim of this study was to compare oral health–related quality of life (OHRQoL) in children with and without molar incisor hypomineralization (MIH) and to assess the impact of severity of MIH on OHRQoL in children between 8–10 years using the German version of the Child Perceptions Questionnaire (CPQ-G8-10).

Materials and methods

Children aged 8–10 years were recruited at a pediatric dental clinic in Hannover, Germany. Half of them were affected by MIH. Participants were evaluated for presence and severity of MIH (MIH-TNI), plaque and dental caries status. Children were asked to answer the CPQ-G8-10. Statistical analysis was performed using GraphPad Prism-software version 8.

Results

One hundred eighty-eight children (mean age 8.80 [± 0.84]; 43.10% female) were included in the study with 94 children having MIH. CPQ-G8-10 mean scores in MIH-affected children were significantly higher than in children showing no MIH (13.87 [± 8.91] vs. 4.20 [± 3.74]; p < 0.0001) showing that MIH has negative impact OHRQoL. Similar trends were seen in all four subdomains. Regarding severity, CPQ-G8-10 mean scores increased from mild to severe forms of MIH.

Conclusion

Children affected by MIH show an impaired OHRQoL compared to children without MIH; with increasing severity, OHRQoL gets more impaired.

Clinical relevance

To understand the patient’s perception and the individual oral health needs will help to prioritize MIH and recognize its impact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04150-w.

Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial

To evaluate the preventive effect of glass ionomer cement (GIC) against dental caries and posteruptive breakdown (PEB) on molars affected by molar incisor hypomineralization (MIH). In this randomized clinical trial, 77 children aged 5-9 years with at least 1 MIH-affected molar and without PEB or dentin caries lesions (n = 228) were included and randomly allocated to one of the following groups: (1) MIH-affected molars that remained unsealed and (2) MIH-affected molars that received GIC sealants. Dental caries and PEB were clinically evaluated after 6 and 12 months. Associations between dental caries and PEB with independent variables were evaluated using logistic regression analysis (p < 0.05). The MIH-affected molars allocated to the GIC sealant group were less likely to develop dental caries compared to those allocated to the unsealed group (OR = 0.23; 95% CI 0.06-0.95). Conversely, application of a GIC sealant was not associated with prevention of PEB (p = 0.313). Furthermore, MIH-affected molars presenting yellow-brown opacities were almost 5 times more likely to develop dental caries (p = 0.013) and PEB (p = 0.001) compared to those presenting white-creamy opacities. We can conclude that GIC sealants can prevent dental caries on MIH-affected molars; however, the same protective effect was not observed for PEB.

Association of microabrasion and tooth whitening with LED/laser system in the treatment of incisor hypomineralization: 3-year follow-up

The hypomineralization of enamel is characterized as a defect in the quality of the enamel during the maturation process. This presents with clinical consequence as a whitish and rough appearance that effects the aesthetics of the dental elements. In recent years there has been a significant increase in this pathology, which has led to a great demand from professionals in the search for knowledge and appropriate technique to treat cases. Minimally invasive therapy may be sufficient for the aesthetic return of the altered enamel. Thus, the present clinical case aimed to present an aesthetic treatment of enamel hypomineralization in the upper incisors with a minimally invasive approach of association of microabrasion with low concentration tooth whitening photoaccelerated by violet LED and infrared laser. The follow-up of the case was performed for 3 years and the association of the techniques proved effective in returning the aesthetics and well-being of the patient, appearing as a good conservative alternative for the treatment of enamel hypomineralization.

Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup &amp; Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician.

Two-Year Survival of High-Viscosity Glass Ionomer in Children with Molar Incisor Hypomineralization

OBJECTIVE

We assessed the clinical survival of a high-viscosity glass ionomer (HVGI) at the 2-year follow-up to restore molar incisors severely affected by hypomineralization after selective carious tissue removal (SCR). The null hypothesis tested was that there are no differences in the overall survival times in the categories of the variables of interest.

METHODS

A total of 134 fully erupted first molar incisors with hypomineralization, cavitated and with moderate-to-deep carious lesions without hypersensitivity or pain (MIH treatment need index 2a-c), were included in the study. HVGI (Equia Forte®; GC, Tokyo, Japan) restorations were applied after SCR to soft carious dentin. The follow-up lasted 2 years. The end point was defined as the absence of endodontic and restorative complications. Two-year, and 18-, 12-, and 6-month survival probabilities and standard errors were calculated using the Kaplan-Meier method. Survival probabilities according to patient gender, jaw, and lesion severity groups were compared using the log-rank test. Restorations were evaluated using the modified US Public Health Service criteria.

RESULTS

HVGI restorations showed cumulative survival probabilities of 95.5% at 6 months, 94% at 12 months, 87.5% at 18 months, and 87.5% at 24 months. Survival probabilities according to patient gender, jaw, and lesion severity groups were not statistically significantly different (p > 0.05). Therefore, the null hypothesis was accepted.

CONCLUSION

Following SCR, HVGI restoration provided moderate survival probabilities, suggesting that the SCR technique is effective.

Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial

OBJECTIVE

To evaluate the influence of fluoride varnish (FV) therapies or resin infiltration (RI) to maintain the structural integrity of Molar Incisor Hypomineralization (MIH) -affected teeth.

METHODS

Fifty-one children aged 6-12 years with at least one incisor and one first permanent molar with yellow/brown MIH opacities were included. Patients were randomly allocated into three groups: FV - Fluoride Varnish (Duraphat); FV+etch - Fluoride Varnish (Duraphat) after enamel etching with 37% phosphoric acid; or RI - Resin Infiltration system (Icon). Opacities were monitored for 18 months. The primary outcome was the loss of integrity due to post-eruptive enamel breakdown (PEB). Covariables included sex, age, DMFT index, opacity colour, plaque index, number of MIH-affected teeth, and number of MIH-affected surfaces. Fisher's Exact was used to test the association of treatments with PEB, the Kaplan-Meyer method analysed the survival rates and Cox-regression determined which covariables would predict failure (α=0.05).

RESULTS

From a total of 235 teeth, the PEB rate for RI (6.1%) was significantly lower (p<0.05) than FV (17.9%; OR 3.0, 95%CI 1.07, 8.48) and FV+etch (17.3%; OR 3.1, 95%CI 1.13, 8.73). DMFT index >3, brown opacities, cusp involvement, and age between 6-8 years predicted PEB (p<0.05).

CONCLUSIONS

Resin infiltration positively influenced the structural integrity maintenance of MIH-affected teeth by decreasing the risk of enamel breakdown over18 months follow-up. Registry of Clinical Trials (RBR-8wwk3n).

CLINICAL RELEVANCE

Resin infiltration proved to be a more efficacious intervention to maintain the structural integrity of MIH-affected teeth than fluoride varnish therapies.

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.

Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial

OBJECTIVE

This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported dental pain and dental anxiety.

MATERIAL AND METHOD

FPMs with MIH of 35 patients aged 7 to 16 years were included. The FPMs were randomized into the following two groups: total-etch (TE-37% phosphoric acid etching) and self-etch (SE-no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale-revised) were evaluated before treatment and at 1, 6, and 12 months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods.

RESULTS

A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1 month, 90.5% (TE) and 80.6% (SE) after 6 months, and 80.8% (TE) and 62.3% (SE) after 12 months (p > 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (p < 0.05). Self-reported pain decreased after 1 month in SE, but it occurred at 6 months in TE.

CONCLUSION

Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels.

CLINICAL RELEVANCE

A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.

The prevalence of molar incisor hypomineralization of school children in and around Muvattupuzha, Kerala

BACKGROUND

Molar incisor hypomineralization (MIH) is a developmental dental defect and has a significant impact on the quality of life of affected individuals. Most of the prevalence studies of MIH have been carried out in the European countries; very little data are available from India.

AIM

The aim and objective of this study was to determine the prevalence of MIH in 8-15-year-old Malayalee school children in and around Muvattupuzha, Kerala.

SETTINGS AND DESIGN

A cross-sectional epidemiological study was conducted in 5318 healthy Malayalee school children aged between 8 and 15 years in and around Muvattupuzha.

MATERIALS AND METHODS

The first permanent molars (FPMs) and all permanent incisors were examined for MIH using the European Academy of Paediatric Dentistry 2003 diagnostic criteria. The severity of hypomineralization was recorded according to the Wetzel and Reckel scale.

STATISTICAL ANALYSIS

The data were analyzed using the Statistical Package for the Social Sciences software version 20.0, and a comparison between groups was carried out using the Chi-square test. P ≤ 0.05 was considered for statistical significance.

RESULTS

A total of 216 children were diagnosed with MIH. The maximum MIH-affected tooth was found to be mandibular right FPM (186), followed by mandibular left FPM (172), maxillary left FPM (160), and maxillary right FPM (156).

CONCLUSION

The prevalence of MIH in permanent dentition of Malayalee school children in and around Muvattupuzha was 4.1%. Among the MIH-affected children, very few have undertaken dental treatment for the same. Hence, proper awareness and planned preventive and restorative programs are required to minimize the problem.

Molar incisor hypomineralization: Analysis of asymmetry of lesions

Clinically, Molar-Incisor Hypomineralization (MIH) lesions are not distributed symmetrically, and their severity varies even within the same arcade.

AIM

To estimate the frequency of asymmetries in hypomineralized lesions on permanent molars and incisors of children with MIH.

METHODS

Three pediatric dentists, calibrated following the diagnostic criteria of Mathu-Muju and Wright (2006) (Kappa 0.87) identified presence and severity of opacities on molars and incisors of patients with MIH. Six pairs of teeth (permanent maxillary and mandibular first molars, central and lateral incisors) were evaluated in each patient. Degree of lesion severity (0-none, 1-mild, 2-moderate, 3-severe) was recorded for each tooth. For each pair containing any affected teeth, asymmetry of presence (one tooth in the pair with lesion and the other intact), asymmetry of severity (both teeth with lesions but with different degrees of severity) or symmetry of severity (both affected teeth with the same degree of severity) were evaluated. The recorded values were entered into a database to calculate percentages, 95% confidence intervals and Chi-Square test for comparisons.

RESULTS

The sample consisted of475 of the 1032 pairs of teeth evaluated in the 172 patients included in the study, mean age 11±2.2 years, and 50% female. Asymmetry was found for 67.5% (63.1 - 71.7) of the pairs of the studied teeth. There was a significant relationship between asymmetries and symmetries (p=0.038). A total 50.1% of the pairs were asymmetrical for presence of opacities. Of these, 62.2% scored severity 1 (mild). Symmetry of severity was found for 32.5% of the lesions. Among the pairs of affected teeth, the most frequently observed degrees of lesion severity were mild and moderate, with the exception of lower molars, in which 49% had severe lesions.

CONCLUSIONS

In this study, MIH lesions were asymmetrical both in presence and severity for all tooth types.

Molar incisor hypomineralization and pre-eruptive intracoronal lesions in dentistry-diagnosis and treatment planning

The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization (MIH) and pre-eruptive intracoronal lesions (PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children. MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and re-mineralizing glass-ionomer cement.

Molar Incisor Hypomineralization-An Emerging Burden: A Short Study on Prevalence and Clinical Characteristics in Central Delhi, India

Aim

To determine the prevalence of molar incisor hypomineralization (MIH) in 6–12 years old children of the Central Delhi area.

Materials and methods

This cross-sectional descriptive short study consisted of 1,026 children aged 6–12 years selected by a random sampling procedure. The parents were interviewed and relevant prenatal, perinatal, and postnatal history was recorded. The dental examination was carried out by well-trained pediatric dentists. Full mouth examination of teeth was conducted including the European Academy of Pediatric Dentistry (EAPD) 2003 criteria for the diagnosis of MIH. The results were documented and statistically analyzed using the Chi-square test.

Results

The prevalence of MIH was found to be 1.17%. There was statistically significant difference in prevalence related to gender (p < 0.05) with a higher number of males affected with MIH. A total of 77 teeth (44 molars and 32 incisors) were observed with MIH. The severity of MIH was more in molars (52.27%) when compared to incisors (24.24%). All the four first permanent molars were affected in 83.3% of children with MIH.

Conclusion

The prevalence of MIH in a small sample of 1,026 children aged 6–12 years in Central Delhi was 1.17%. A significant male predilection was reported. MIH is a developmental disturbance occurring during the maturation phase of enamel formation, which requires a multidisciplinary treatment approach. The high esthetic demand and the inability to deliver successful restorative care to the hypomineralized teeth can pose great difficulties. Hence, more studies related to prevalence, nature, and severity of MIH and awareness regarding the associated risk factors are required to reveal the hidden burden across the country and to further prevent the occurrence of MIH.

How to cite this article

Goswami M, Bhushan U, et al. Molar Incisor Hypomineralization—An Emerging Burden: A Short Study on Prevalence and Clinical Characteristics in Central Delhi, India. Int J Clin Pediatr Dent 2019;12(3):211–214.

Knowledge, perceptions, and clinical experiences on molar incisor hypomineralization among dental care providers in Hong Kong

BACKGROUND

Molar incisor hypomineralization (MIH) is an alarming problem with considerable challenges in management. This study aimed to evaluate and compare the knowledge, perceptions, and clinical experiences of molar incisor hypomineralization (MIH) between general dental practitioners (GDPs) and paediatric dentists (PDs) in Hong Kong.

METHODS

A cross-sectional survey of 557 randomly selected GDPs (approximately 25% of all registered dentists) and all registered PDs (n = 31) were invited. They were asked to complete a 4-section questionnaire adapted and modified from a study by Gambetta-Tessini and co-workers on sociodemographic profiles, knowledge, experience, and perceptions regarding MIH. Data were analyzed with chi-square, Fisher's exact, and multiple factor ANCOVA tests.

RESULTS

The overall response rate was 43.37% (255/588). Majority (74.1%) of the respondents encountered MIH in their practices. A significantly higher mean knowledge score (46.33 ± 7.1) was observed among PDs than GDPs (43.09 ± 7.0) (P < 0.01) and among PDs who are 40 years old or younger (P < 0.001). Differences in treatment of MIH were also observed between PDs and GDPs (P < 0.05). Paediatric dentists were more confident in diagnosing and treating MIH (P < 0.001). Most respondents (87.8%) expressed a need for continuing education on MIH.

CONCLUSION

Continuing education on MIH is needed to assure that the highest quality of evidence-based care is given to patients with MIH. Dissemination of latest best evidence on MIH, especially to GDPs, will assure that the condition is accurately diagnosed and well managed.

Prevalence of molar incisor hypomineralization and regional differences throughout Japan

Background

Molar incisor hypomineralization (MIH) frequently occurs in children worldwide. However, MIH prevalence throughout Japan has not yet been investigated. The purpose of this study was to clarify MIH prevalence rates and to consider potential regional differences throughout Japan.

Methods

A total of 4496 children aged 7–9 years throughout Japan were evaluated in this study. MIH prevalence rates among children were evaluated in eight regions throughout Japan. A child’s residence was defined as the mother’s residence during pregnancy. The localization of demarcated opacities and enamel breakdown was recorded on a standard code form using a guided record chart. Logistic regression analysis was used to evaluate whether MIH prevalence rates differed among age groups, sex, and regions.

Results

The overall prevalence of MIH in Japan was 19.8%. The prevalence of MIH was 14.0% in the Hokkaido region, 11.7% in the Tohoku region, 18.5% in the Kanto Shin-Etsu region, 19.3% in the Tokai Hokuriku region, 22.3% in the Kinki region, 19.8% in the Chugoku region, 28.1% in the Shikoku region, and 25.3% in the Kyushu region. These regional differences were statistically significant. Moreover, MIH prevalence rates decreased with age. No significant sex differences in MIH prevalence rates were demonstrated.

Conclusions

To our knowledge, this is the first MIH study carried out in several regions throughout Japan. Regional differences existed in MIH prevalence rates; particularly, MIH occurred more frequently in children residing in southwestern areas than those in northeastern areas of Japan.

Molar Incisor Hypomineralization: Prevalence and Risk Factors Among 7-9 Years Old School Children in Muradnagar, Ghaziabad

Background

The aim of this school-based, cross-sectional survey was to investigate the prevalence and risk factors of permanent Molar Incisor Hypomineralization among 7-9 years old school children in Muradnagar.

Methods

This cross-sectional study was performed among 7-9 years old school children in Muradnagar. Estimated sample size was 992 in this study. Multistage cluster sampling technique was used in this study in which schools were the clusters which were selected randomly. The study proforma was divided into 2 parts, first part comprised of demographic status, socio-economic status, questionnaires on risk factors of Molar Incisor Hypomineralisation such as prenatal, perinatal and postnal history upto 3 years, feeding pattern, fluoride and other pollutants exposure history, dental history, history of trauma to teeth/face, family history of enamel defects which was asked to the mothers and filled by one examiner in a face to face interview. The second part comprised of recording format of clinical variables assessed by investigator to be recorded by the recording clerk. Molar incisor hypomineralisation were recorded using Modified Developmental Defect of Enamel index developed by Clarkson J.J. and O' Mullane D.M. in 1989 and dental caries by using Decayed Missing Filled Tooth index (World Health Organization Modification 1997) in which WHO probe was used for examination of dental caries as recommended by WHO in the Oral Health Surveys, Fourth edition; 1997 (Spanish version). Before 1997 modification dental explorer was used for the examination of dental caries. Chi square test, Pearson's Correlation test, Logistic Regression Analysis and Unpaired t-test were used for analysing the data.

Results

The overall prevalence rate of Molar incisor hypomineralisation was 21.4% in this study. Age, problems during pregnancy, normal delivery and childhood illness/ infections are the risk factors which have highest strength of association.

Conclusion

In the present study Molar incisor hypomineralisation was found to affect 2 out of every 10 children examined which was higher than that observed in other studies on Indian children.

Endemic Molar Incisor Hypomineralization: a Pandemic Problem That Requires Monitoring by the Entire Health Care Community

PURPOSE OF REVIEW

This review brings a major, previously under-recognized dental and general health problem to the attention of the medical and scientific community. The goals are to help clinicians make early diagnoses, thereby improving treatment outcomes, and to stimulate increasing research efforts to understand the etiology and ultimately prevention.

RECENT FINDINGS

There are two recent systematic reviews of molar incisor hypomineralization (MIH). One reveals the global burden of the condition; mean global prevalence is 13% with 878 million people affected, with 4.8 million cases per year requiring treatment. The review into etiology found a lack of definitive knowledge, but that it is likely to be multifactorial, with childhood illness including fever possibly implicated. The review presents details of MIH sufficient to enable clinicians to recognize it and understand its impact on affected children, its management, and the importance of early intervention. Much further research is needed.

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.

Bonding strategies for MIH-affected enamel and dentin

OBJECTIVES

Aim of the present study was to evaluate resin composite adhesion to dental hard tissues affected by molar incisor hypomineralisation (MIH).

METHODS

94 freshly extracted human molars and incisors (53 suffering MIH) were used. 68 teeth (35 with MIH) were used for μ-TBS tests in enamel and dentin, 26 (18 with MIH) for qualitative evaluation. Specimens were bonded with Clearfil SE Bond, Scotchbond Universal, and OptiBond FL. For MIH affected enamel, additional OptiBond FL groups with NaOCl and NaOCl+Icon were investigated. Beside fractographic analysis, also qualitative evaluations were performed using SEM at different magnifications as well as histological sectioning.

RESULTS

Highest μ-TBS values were recorded with dentin specimens (ANOVA, mod. LSD, p<0.05). Results were independent of adhesive and dentin substrate (p>0.05). Pre-test failures did not occur in dentin specimens. Sound enamel specimens exhibited significantly higher μ-TBS values than MIH enamel (p<0.05). The two-step self-etch adhesive (Clearfil SE Bond) and the two-step etch-and-rinse adhesive (Scotchbond Universal) showed the lowest values in affected enamel specimens (p<0.05) with most pre-test failures (p<0.05). OptiBond FL on affected enamel showed better results than Clearfil SE Bond (p<0.05). An additional pre-treatment of affected enamel with NaOCl or NaOCl and Icon did not enhance enamel bonding (p>0.05), however, it caused less pre-test failures (p<0.05). Micromorphological analyses revealed that conventional phosphoric acid etching produces a much less pronounced etching pattern in affected enamel and a porous structure as weak link for the resin-enamel bond was identified.

SIGNIFICANCE

Bonding to porous hypomineralized MIH enamel is the limiting factor in adhesion to MIH teeth. MIH-affected dentin may be bonded conventionally.

Risk factors associated with new caries lesions in permanent first molars in children: a 5-year historical cohort follow-up study

OBJECTIVE

The objective of this study is to analyze the factors associated with the occurrence of caries in the permanent teeth (PT) and in the permanent first molar (PFM) 5 years after their eruption.

MATERIAL AND METHODS

Children born in 2005 and enrolled in a community dental program were included. The inclusion criteria were: age 10 years in 2015; the availability of clinical dental history (CDH) data from before eruption of the PT and a follow-up period of 5 years after eruption of the PT. A total of 206 children were enrolled. Risk factors evaluated were: caries experience in the mother, educational level of the mother, frequent drug use, systemic diseases, eating habits, brushing frequency, presence of molar incisor hypomineralization (MIH) in PT, and caries in deciduous teeth (DT). Associations between explanatory factors and the DMF-T (decayed, missing, filled teeth in PT) and DMFT-M (DMF in PFM) indexes, independently considering cavitated or cavitated and non-cavitated caries as outcomes, were evaluated by poisson regression with robust variance analysis.

RESULTS

In the multivariate analysis, a cariogenic diet, especially soft drinks, was associated to high DMF-T and DMFT-M scores when both cavitated and non-cavitated caries were considered. A brushing frequency < 1 a day was significantly associated to high DMF-T scores. The presence of df-t (decayed and filled temporary teeth) score > 0 and MIH conditioned high DMF-T or DMFT-M values, considering cavitated or cavitated and non-cavitated caries.

CONCLUSIONS

The intake of sweets and soft drinks, brushing frequency, caries in DT, and MIH in PT were the best predictors of caries in PT.

CLINICAL RELEVANCE

Control of risk factors in early childhood is important for preventing caries in PT.

Prevalence of Molar Incisor Hypomineralization in Mexican Children

OBJECTIVE

To determine the prevalence of and factors associated with molar incisor hypomineralization (MIH) in schoolchildren aged 6-12 years.

STUDY DESIGN

This study included 1156 schoolchildren aged 6-12 years, living in Mexico City. A previously standardised examiner (k = 0.79) applied the diagnostic criteria for MIH from the European Academy of Paediatric Dentistry. Children's parents completed a questionnaire about medical conditions in the perinatal period and the first 3 years of their children's lives. Descriptive measures were examined, multivariate logistic regression analysis was performed, and odds ratios (ORs) were calculated.

RESULTS

The subjects were 582 (50.4%) females and 574 (49.6%) males, with an average age of 8.4 ± 1.6 years. The prevalence of MIH was 15.8%, and this condition was more prevalent in children aged 9-12 years than in those aged 6-8 years (18% vs. 13.7%, p < 0.05). Risk factors for MIH were low birth weight (OR = 1.905, 95% confidence interval [CI] 1.130-3.211, p = 0.014), urinary tract infection (OR = 4.841, 95% CI 2.863-8.186, p = 0.001), chickenpox (OR = 1.826, 95% CI 1.196-2.786, p = 0.005), and history of allergies (OR = 4.370, 95% CI 2.538-7.523, p < 0.001).

CONCLUSIONS

The prevalence of MIH in a group of Mexican schoolchildren was 15.8%. Medical conditions in the first years of life were more prevalent in children affected by MIH.

Do We Really Know the Prevalence of MIH?

AIM

To analyze the existing variability on molar incisor hypomineralization prevalence in the literature; to distinguish the various molar incisor hypomineralization prevalence rates in different countries, areas, and regions of the world; and to know the valid diagnostic criteria used for the correct identification of molar incisor hypomineralization prevalence.

STUDY DESIGN

A literature review from Medline and Cochrane Library online databases was performed using five terms individually or in combination. Articles not reporting diagnostic criteria employed and articles not written English were excluded. The results were analyzed by country, region, year of study, sample size, range of age, and prevalence rate.

RESULTS

A total of 37 articles in English were selected from 1987 to 2014 and from those only 14 employed the EAPD's 2003 diagnostic criteria. The reported age range varied from 5.5 to 17 years; the most frequently range used was 7 to 9 years. A wide prevalence range from 2.8% to 44% was found and 82.61% of the articles reported calibrated examiners.

CONCLUSIONS

Comparison among the results of the studies is difficult due to the use of different indexes and diagnostic criteria, the analysis variability, selection methods, and different age groups. In reality, we are probably far from knowing the real MIH prevalence.

Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization

INTRODUCTION

The restorative management of molars with molar incisor hypomineralization (MIH) represents a challenge in the clinical practice with high failure rate.

OBJECTIVE

The aim of this study is to evaluate the clinical survival of direct composite resin restorations in first permanent molars (FPMs) that are affected by MIH, comparing two adhesive systems.

MATERIAL AND METHODS

We selected 41 FPMs with MIH from children aged 6-8 years. FPM fully erupted and with restorative treatment needed were the inclusion criteria. We excluded FPMs with destroyed crowns. The FPMs were randomly assigned to two groups: self-etching adhesive (SEA) and total-etch adhesive (TEA). Clinical evaluation was performed by a blinded examiner during 18 months according to the modified US Public Health Service (USPHS) criteria. The actuarial method was used to evaluate survival of the restorations, and Chi-square and Fisher's exact tests were used to compare differences between the groups (α = 5 %).

RESULTS

The cumulative survival rates were 100 % at 1 month, 89 % at 6 months, 73 % at 12 months, and 68 % at 18 months in SEA, and 95 % at 1 month, 72 % at 6 months, 59 % at 12 months, and 54 % at 18 months in TEA; there was no significant difference between groups.

CONCLUSIONS

There was no difference in clinical survival of restorations in FPMs affected by MIH using TEA or SEA adhesives in the end of 18 months.

CLINICAL RELEVANCE

It was suggested that SEAs as well as TEAs can be applied to restore molars affected by MIH, when it is performed a conservative cavity preparation. Once, cavosurface margins (cavity design) in hypomineralized enamel have less bonding capability.

Treatment decisions on Molar-Incisor Hypomineralization (MIH) by Norwegian dentists - a questionnaire study

Background

The study aimed to explore the variability between the treatment decisions dentists make for MIH-affected teeth.

Methods

In 2009, a pre-coded questionnaire was sent electronically to all dentists employed by the Public Dental Service (PDS) in Norway (n = 1061). The questions were related to treatment of MIH-affected teeth, including three patient cases illustrated by photographs and written case descriptions.

Results

Replies were obtained from 61.5 % of the respondents after two reminders. In the first case, showing a newly erupted first permanent molar with moderate hypomineralization and no disintegration of the surface enamel, the preferred treatment among the majority of the respondents (53.5 %) was application of fluoride varnish, while 19.6 % would seal the fissure with GIC material. In the second case, showing a severely damaged first permanent molar in a six year old child, more than half of the respondents (57.5 %) would place a conventional glass ionomer restoration and 10.5 % would use a stainless steel crown (SSC). In the third case, showing a severely damaged permanent first molar in a nine year old child, 43.8 % of the dentists would remove only the parts with soft, damaged enamel; while 35.2 % would remove more and 21.0 % would remove all affected enamel and leave the cavity margins in sound enamel.

Conclusions

The survey shows that there is a wide disparity between clinicians’ views on how MIH affected teeth should be treated. In a severely affected first permanent molar, only a minority of dentists would remove as much tooth substance as needed to get the full benefit of the acid etch pattern in sound enamel.

Molar Incisor Hypomineralization

Molar incisor hypomineralization (MIH) is a developmental defect affecting teeth. High prevalence rates of MIH and its clinical implications are significant for both the patients and clinicians. A wide variation in defect prevalence (2.4-40.2%) is reported. It seems to differ with regions and various birth cohorts. Some of the recent prevalence studies are tabulated. Patient implications include hypersensitive teeth, rapid progression of caries, mastication impairment due to rapid attrition, and esthetic repercussions. Implications for clinicians include complexity in treatment planning and treatment implementation, poor prognosis of the restorations, difficulty in achieving pain control during treatment, and behavior management problems. Intention of this paper is to review the etio-pathogenesis, prevalence, clinical features, diagnostic features, and eventually present a sequential treatment approach, i.e., in accordance with current clinical practice guidelines.