Molar incisor hypomineralisation: prevalence and clinical presentation in school children of the northern region of India

Is there a rise of prevalence for Molar Incisor Hypomineralization? A meta-analysis of published data

Since Molar Incisor Hypomineralization was first described as a pathologic entity, public perception often suggests a considerable rise in prevalence of the respective disease. Since there are still considerable doubts regarding the etiology and-accordingly-prevention of MIH and respective therapeutic approaches are difficult this question is of considerable clinical and public interest. Accordingly, a systematic literature search in accordance with the PRISMA guidelines for systematic reviews on Medline, Cochrane Database, EMBASE, LILACS, Web of Science, Google scholar, Scopus was performed to retrieve original articles reporting the prevalence of MIH as defined by the European Academy of Pediatric Dentistry (EAPD). From initially 2360 retrieved titles, 344 full texts were assessed for possible inclusion and finally 167 articles of mainly moderate to high quality and based on data of 46'613 individuals were included in the meta-analysis. All studies published before 2001 had to be excluded since it was not possible to align the findings with the EAPD classification. Studies varied considerably regarding cohort size (25 to 23'320, mean 1'235)) and age (5.6-19 y, mean 9.8 y). Over all studies, the weighted mean for the prevalence for MIH was 12.8% (95% CI 11.5%-14.1%) and no significant changes with respect to either publication year or birthyear were found. A sub-analysis of eleven studies reporting on the prevalence in different age groups, however, revealed strong evidence for an increasing prevalence between the years 1992 (3%) and 2013 (13%).Therefore, based on data from cross-sectional studies a possible rise in prevalence of MIH remains unclear. Future prospective large-scale studies under standardized examination conditions with an emphasis on examiner calibration are needed to gain better understanding in the evolution of the prevalence of MIH.

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

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

Molar-incisor hypomineralisation prevalence in a cohort of Australian children with type 1 diabetes

PURPOSE

Systemic diseases or drugs administered early in life may cause a disruption in amelogenesis and contribute to the qualitative defect of enamel described as molar-incisor hypomineralisation (MIH). Therefore, an increase in prevalence of MIH in children with type 1 diabetes (T1D) may be expected as this systemic disorder is commonly diagnosed in early childhood. The aim of this study was to determine the prevalence of MIH in a cohort of children with T1D and investigate diagnosis of MIH with T1D factors.

METHODS

Cross-sectional study of children with T1D recruited from paediatric diabetes clinics at the Women's and Children's Hospital (South Australia). A detailed medical history, comprehensive dental and MIH examination according to the European Academy of Paediatric Dentistry (EAPD) long form classification was collected for each child. All upper and lower first permanent molars and central incisors were scored.

RESULTS

A total number of 73 participants; 35 (47.95%) males were examined including 584 teeth. The mean age of the participants was 13.25 ± 2.58 years, with a mean age of diagnosis 7.75 ± 3.58 years, and a mean HbA1c of 8.5 ± 1.6%. 42 out of 73 children (54.8%) had enamel defects on at least one of the teeth examined. However, 19.2% met the criteria for MIH. Univariate and bivariate analyses were conducted but no significant associations were noted between MIH and risk factors including diabetes control (p > 0.1).

CONCLUSION

There was a high prevalence of enamel defects and MIH amongst children with T1D. More research is required to establish association between T1D and MIH.

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.

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.

Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial

BACKGROUND

Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations.

AIM

To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs).

METHODS

60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months.

RESULTS

After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups.

CONCLUSION

Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.

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

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

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.

Molar incisor hypomineralization: A review and prevalence in Japan

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

The Prevalence and Etiology of Molar-Incisor Hypomineralization among Female School Children

Background:

Molar-Incisor Hypomineralization (MIH) is a developmental defect affecting teeth. The prevalence of MIH and its clinical implications form a challenge for patients and dentists.

Objective:

The purpose of this study was to determine the prevalence of MIH among female school children in Makkah, Saudi Arabia.

Methods:

A cross-sectional study was conducted including 7- to 9-year-old school girls from the public and private sectors. Invitations to participate in the study were sent to the parents of 1,000 randomly selected children, along with questionnaire and consent form. All included children were examined by two dentists who had been previously calibrated in the assessment of MIH (K=0.9), which was diagnosed according to the European Academy of Paediatric Dentistry 2003 criteria. Data analysis was done using SPSS V.22.0 and various statistical tests were conducted to determine significant differences at P<0.05.

Results:

A total of 711 children participated in this study, with a response rate of 82.2%. The prevalence rates of MIH and Molar Hypomineralization (MH) were 20.96% and 26.58%, respectively. The most common form of MIH was the mild form (87.24%), while 18 children (12.08%) were diagnosed with the moderate form. A single child (0.67%) was diagnosed with the severe form. No statistically significant associations were found between MIH/MH and prenatal, perinatal or postnatal factors.

Conclusion:

The prevalence of MIH in school girls in Makkah was 20.96%. Despite its high prevalence, the severity of MIH was relatively mild. The etiology of MIH remains unclear and warrants further investigation in future studies.

Prevalence, aetiology, and treatment of molar incisor hypomineralization in children living in Izmir City (Turkey)

BACKGROUND

Molar incisor hypomineralization (MIH) is frequent in children and etiology is different.

AIM

The aim of this study was to determine the prevalence, severity, and risk factors of MIH and to investigate the relationship between the severity of the defect in the teeth affected by MIH and the risk factors.

DESIGN

The study included patients at the age range of 9 and 10 years, who were admitted to the clinic of paediatric dentistry in Dokuz Eylul University and had four-first molar teeth (FMT) and eight incisor teeth eruptions in the jaws. The presence of only demarcated opacities in one or several FMT and incisor teeth was defined as MIH1, and the presence of post-eruptive breakdown (PEB), atypical restorations, and extracted teeth was defined as MIH2.

RESULTS

MIH was detected in 142 (11.5%) of 1237 children. Although there was no statistically significant difference between upper and lower FPM and the occurrence of MIH (P < 0.902), there was a difference between upper and lower central and lateral teeth (P < 0.001; P < 0.009). A significant difference was detected between birth week, birthweight, high fever, and asthma/bronchitis and MIH1 and MIH2 (P < 0.001).

CONCLUSION

The prevalence of MIH was found to be 11.5%. It was observed that the patients undergoing low birthweight, preterm delivery, high fever, and asthma/bronchitis were more severely affected by MIH.

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization

This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

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.

Prevalence and etiology of molar-incisor hypomineralization (MIH) in the city of Istanbul

Background/purpose

Molar-Incisor-Hypomineralisation (MIH) is the term used to depict a condition in which one or more of the permanent molar teeth and usually no less than one incisor tooth is hypomineralised and the prevalence rates vary from 2.4 to 40.2%. The aim of this study was to assess the prevalence and the risk factors of MIH in children in Istanbul, Turkey.

Materials and methods

A total of 1511 (760 M, 751 F), 8- to 11-year-old children were examined who had their first permanent molar and incisors evaluated using the EAPD criteria for MIH. Hypomineralized molars and incisors were recorded based on developmental defects of enamel index. The potential aetiological factors were retrieved through personal interview and etiological questions were asked to the parents. Statistical analysis was performed with a chi-Square test.

Results

MIH was observed in 215 (14.2%; 102 male, 113 female) children. The sample (1511 children) comprised 71 (9.9%) 8 year-olds with MIH and 144 (18.2%) 11 year-olds with MIH. A significant difference was found between 8 (9.9%) and 11-year-old (18.2%) children with MIH (p ≤ 0.001). Complications during the mother's pregnancy, birth prematurity, average breast feeding period, diarrhea frequency, digestive system diseases, asthma, frequent high fever, ear infection, renal failure, rubeola, chickenpox and parotitis were found to be significantly associated with MIH (p < 0.001).

Conclusion

There are many events that can cause MIH which we cannot control or predict. Therefore, longitudinal studies with large sample size are needed so as to determine how various likely etiological factors described affect the etiological role.

First Permanent Molars and Permanent Incisors Teeth by Tooth Prevalence of Molar-Incisor-Hypomineralisation in a Group of Spanish Schoolchildren

Background

Molar-incisor-hypomineralisation (MIH) is a disturbance in dental development that commonly involves first permanent molars but permanent incisors may also be compromised. The prevalence of MIH in the literature varies between 2.5% and 40% of the world child population. Little information is gained on the prevalence of MIH among children in Spain.

Aim

The aim of this study was to investigate the prevalence of MIH among school children from Barcelona, Spain.

Material and methods

A cross-sectional study which included 705 children, aged 6 -14 years and 11 months was carried out. Full mouth examinations were performed using the European Academy of Paediatric Dentistry (EAPD) criteria for the diagnosis of MIH.

Results

A total of 56 cases of MIH were found, 22 (39.3%) boys and 34 (60.7%) girls. The prevalence was 7.94% (6.39% for boys and 9.41% for girls). MIH lesions were seen more often in girls than boys (χ² = 4.9, p= 0.023) the male/female ratio being 1:1.54. Upper teeth were more prevalent than lower teeth in both genders with an upper/lower ratio of 1.86/1 for boys and 1.68/1 for girls.

Conclusion

Considered either by gender or by teeth, upper teeth and girls were ahead in our sample.

Efficacy of Intraosseous Local Anesthesia for Restorative Procedures in Molar Incisor Hypomineralization-Affected Teeth in Children

Background

Treatment of teeth affected with molar incisor hypomineralization (MIH) in young patients is challenging due to chronic subclinical pulpal inflammation caused by porous enamel and exposed dentin. Hypersensitivity of the teeth and difficulty in achieving local anesthesia due to altered nerve potential affects the successful completion of the treatment.

Aim

The aim of the study was to compare the anesthetic efficacy of the intraosseous (IO) anesthetic technique with conventional local infiltration technique in anesthetizing first permanent molars (FPMs) affected by MIH for restorative procedures in children.

Materials and Methods

This randomized controlled clinical trial recruited 54 MIH-affected mandibular or maxillary FPMs requiring restorations or stainless steel crowns. The teeth were randomly allocated to two equal groups to receive either IO injection or buccal infiltration (control), both using 4% articaine. Onset, time required, and pain experienced for administration, need for repeat, efficacy of anesthetic technique, heart rate, and postoperative complications were recorded in both the groups. Collected data were subjected to statistical analysis.

Results

Onset was significantly faster and pain experienced during administration was significantly lower with IO technique. Need for repeat of anesthesia was significantly more with infiltration (44.4% vs. 7.4% in IO, P = 0.004). Local infiltration failed to produce profound anesthesia in 74.1% MIH-affected teeth. IO anesthesia profoundly anesthetized 88.9% MIH-affected teeth. Anesthetic efficacy was significantly better with IO anesthesia (P < 0.001). Postoperative complications were significantly lower with IO anesthesia (P = 0.003).

Conclusion

IO local anesthesia was found to be an effective and safe technique to achieve profound anesthesia in MIH-affected teeth in children in comparison to local infiltration.

Phenotypes of Enamel Hypomineralization and Molar Incisor Hypomineralization in Permanent Dentition: Identification, Quantification and Proposal for Classification

OBJECTIVES

To report the extent, pattern, clinical presentation and phenotypes of enamel hypomineralization in permanent dentition Study Design: This cross sectional observational study recruited a random sample of 1726, 12-16 year olds. Enamel hypomineralization was scored on all teeth by a calibrated examiner using the EAPD 2003 criteria. Proportions of affected subjects (prevalence) with a minimum of one hypomineralization and Molar Incisor Hypomineralization (MIH) were calculated. Proportions of following phenotypes were quantified i.e. MH (only FPM hypomineralization), M+IH (concomitantly affected FPMs and permanent incisors without affecting any other tooth in the arch), MIHO (hypomineralization affecting at least one of the canines, premolars or 2(nd) molars and simultaneously including at least one FPM), IH (only permanent incisor's hypomineralization) and NoFPM (hypomineralization affecting at least one of the canines, premolars and 2(nd) molars but not FPM; incisors can be affected concomitantly). A comparative evaluation of extent and severity of enamel hypomineralization was performed amongst various phenotypes. Statistical measures employed t-test, chi square tests and ANOVA.

RESULTS

Overall prevalence of affected subjects was 13.21% (228/1726) and 9.79% (169/1726) for enamel hypomineralization and MIH respectively. A total of 4.36±3.45 teeth/subject and 6.01±5.20 surfaces/subject were found to be affected with enamel hypomineralization. Most prevalent phenotype was M+IH while the least prevalent was IH. Maximum severity i.e. number of affected surfaces and surfaces with PEB were reported for MIHO (p<0.001).

CONCLUSION

Enamel hypomineralization can manifest in any tooth in five phenotypic variations in permanent dentition with varying extent and severity.

A novel clinical approach for long-term retention and durability of resin restorations bonded to multiple developmental defects of enamel

Dental enamel is a unique, highly mineralized tissue of ectodermal origin. It is characterized by lack of metabolic activity once formed, implying that disturbances during development can manifest as permanent defects in the erupted tooth. Although the etiology of enamel defects may be attributed to local, systemic, genetic, or environmental factors, most are likely to be multifactorial in nature. The time frame of exposure and the mechanism underpinning the causative factors determine the presentation of these defects. These developmental defects of enamel (DDE) may range from slight abnormalities of the tooth's color to a complete absence of the enamel, some of which may be sensed by an individual as being disfiguring and call for treatment to improve the appearance of the dentition. Molar incisor hypomineralization (MIH) is a relatively common condition that varies in clinical severity, remains localized to permanent incisors and first permanent molars, and whose prevalence varies between 2.8 and 25% depending upon the study. Adhesion and retention of resin restorations is challenging in long-term rehabilitation in these cases. This paper presents a novel approach in the functional and esthetic rehabilitation of a 13-year-old female child diagnosed with multiple DDEs.

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.

Prevalence of molar incisor hypomineralization in 7-9-year-old children of Bengaluru City, India

Background:

Molar incisor hypomineralization (MIH) is a developmental defect. The prevalence of MIH ranges widely from 2.4% to 40.2%.

Aim:

This study was under taken to determine the prevalence of MIH in 7–9-year-old children of Bengaluru City, India.

Materials and Methods:

A cross-sectional epidemiological study was conducted in a representative sample of 2500 school children aged 7–9 years of Bengaluru, India. Oral examination was carried out by a single trained calibrated examiner under natural daylight.

Results:

Twelve children (0.48%) were diagnosed with MIH. A total of 68 teeth were observed with MIH. All four first permanent molars were affected in 50% of children. In the molar group, mandibular molars (29.41%) were more frequently affected than maxillary molars (27.94%).

Conclusion:

The prevalence of MIH in 7–9-year-old children of Bengaluru was 0.48%, with no gender predilection.

Assessment of association between molar incisor hypomineralization and hypomineralized second primary molar

Background:

The term molar incisor hypomineralization (MIH) has been described as a clinical entity of systemic origin affecting the enamel of one or all first permanent molars and also the incisors; less frequently the second primary molars have also been reported to develop hypomineralization of the enamel, along with MIH.

Aim:

To scrutinize the association between hypomineralized second primary molars (HSPMs) and MIH and their prevalence in schoolgoing pupils in Nagpur, Maharashtra, India and the associated severity of dental caries.

Design:

A sample of 1,109 pupils belonging to 3–12-year-old age group was included. The entire sample was then divided into Group I (3–5 years) and Group II (6–12 years). The scoring criteria proposed by the European Academy of Pediatric Dentistry for hypomineralization was used to score HSPM and MIH. The International Caries Detection and Assessment System II (ICDAS II) was used for appraising caries status in the hypomineralized molars. The examination was conducted by a single calibrated dentist in schools in daylight. The results, thus obtained, were statistically analyzed using Chi-square test and odds ratio.

Result:

Of the children examined, 10 in Group I (4.88%) had HSPM and 63 in Group II (7.11%) had MIH in at least one molar. In Group II, out of 63 subjects diagnosed with MIH, 30 subjects (48%) also had HSPM. Carious lesions with high severity were appreciated in hypomineralized molars.

Conclusion:

The prevalence of HSPM was 4.88% and of MIH was 7.11%. Approximately half of the affected first permanent molars were associated with HSPM. The likelihood of development of caries increased with the severity of hypomineralization defect.

Prevalence and characteristics of MIH in school children residing in an endemic fluorosis area of India: an epidemiological study

AIM

This was to study the prevalence of molar incisor hypomineralisation (MIH) among school children residing in a fluorosis endemic area in Tamilnadu (Salem, India).

METHODS

A target sample of 5000 children of age ranging between 9 and 14 years, comprising 250 children from each of 20 blocks of Salem, participated in this study. The examination was completed in their respective schools by a calibrated examiner using EAPD criteria.

RESULTS

Of 4989 children examined, 384 children had MIH. A prevalence of 7.3 %. The MIH found in girls was 8.9 % compared with 6.1 % in boys. Single-tooth involvement of MIH was seen predominantly in incisors (2.24 %), whereas with molars usually three teeth were involved (1.1 %). MIH with caries involvement was found in 51 % of the teeth.

CONCLUSION

The prevalence of MIH in the endemic fluorosis district was found to be 7.3 %. A gradual increase in MIH was seen with age due to post enamel breakdown. Caries involvement was also seen in more than 50 % of the MIH-involved teeth. This prevalence study for molar incisor hypomineralisation (MIH) is rare in the literature, especially in a fluorosis endemic district in Tamilnadu.

Standardised studies on Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM): a need

In November 2014, a review of literature concerning prevalence data of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) was performed. A search of PubMed online databases was conducted for relevant articles published until November 2014. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article. Out of 1078 manuscripts, a total of 157 English written publications were selected based on title and abstract. Of these 157, 60 were included in the study and allocated as 52 MIH and 5 HSPM, and 3 for both MIH and HSPM. These studies utilised the European Academy of Paediatric Dentistry judgment criteria, the modified index of developmental defects of enamel (mDDE) and self-devised criteria, and demonstrated a wide variation in the reported prevalence (MIH 2.9-44 %; HSPM 0-21.8 %). Most values mentioned were representative for specific areas. More studies were performed in cities compared with rural areas. A great variation was found in calibration methods, number of participants, number of examiners and research protocols between the studies. The majority of the prevalence studies also investigated possible aetiological factors. To compare MIH and HSPM prevalence and or aetiological data around the world, standardisation of such studies seems essential. Standardisation of the research protocol should include a clearly described sample of children (minimum number of 300 for prevalence and 1000 for aetiology studies) and use of the same calibration sets and methods whereas aetiological studies need to be prospective in nature. A standardised protocol for future MIH and HSPM prevalence and aetiology studies is recommended.

Severity of MIH findings at tooth surface level among German school children

AIM

This study was to investigate the distribution and clinical characteristics of teeth diagnosed with MIH at surface and defect type level in a cohort of German children.

METHODS

The study cohort included 242 children diagnosed with MIH which had been recorded during the compulsory dental school examinations of 20 German primary schools. The subjects had been enrolled by cluster sampling. All children attended the second to fourth grade (age 7-10 years, mean 8.1 ± 0.8). The children were examined by five calibrated examiners (kappa = 0.9) after tooth brushing. The recording comprised teeth, surfaces, type and severity of MIH defects and was conducted using a portable light, mirrors and cotton rolls. MIH was registered according to the EAPD criteria. Defects <1 mm were not recorded. Statistical analysis included descriptive statistics and Spearman's correlation.

RESULTS

Most affected teeth were first permanent molars (71.4 %) followed by the maxillary central incisors (15.6 %). The most common defects were demarcated opacities (82.2 %), while the remaining 17.8 % of the affected teeth exhibited severe enamel defects. The most frequently affected surface in molars was the occlusal surface (72.4 %); in incisors, it was the buccal surface (73.5 %). There were no atypical restorations in the affected incisors. Different types of MIH defects at various surfaces of the same tooth were common. The number of affected tooth surfaces was positively correlated with the severity of MIH at child (p < 0.001).

CONCLUSIONS

The study demonstrates severe enamel defects involving in almost one-fifth of all MIH teeth. The knowledge of the intra-oral distribution and severity of MIH findings at the enamel surface level is important for assessing the treatment needs.

Prevalence of molar incisor hypomineralization (MIH) in Singaporean children

BACKGROUND

There is a lack of data on molar incisor hypomineralization (MIH) in Asia, but this is not an indication that MIH is rare in the Asian population. Early identification of MIH is important as affected teeth frequently display post-eruptive enamel loss which would result in rapid caries progression.

AIM

This objective of this study was to assess the prevalence of MIH in Singaporean children.

DESIGN

Patients were recruited from 30 schools across Singapore. All children were examined by a single dentist, and the judgement criteria used were based on the 2003 European Academy of Paediatric Dentistry criteria.

RESULTS

A total of 1083 children; average age of 7.7 ± 0.3 years were examined. One hundred and thirty-five children (12.5%) had MIH. A significantly higher proportion of children of the Malay ethnicity had MIH, compared to Chinese children (P = 0.02). Post-eruptive enamel breakdown and the presence of atypical restorations were correlated with increasing number of MIH teeth/child (Rho= 0.599, P < 0.001) and the cumulative enamel opacity colour score (Rho = 0.601, P < 0.001).

CONCLUSIONS

Our findings suggest the role of ethnicity in MIH occurrence and that MIH severity may be influenced by the number of MIH teeth/child and the cumulative enamel opacity colour score.