Assessment of Genetical, Pre, Peri and Post Natal Risk Factors of Deciduous Molar Hypomineralization (DMH), Hypomineralized Second Primary Molar (HSPM) and Molar Incisor Hypomineralization (MIH): A Narrative Review

Prevalence of hypomineralised second primary molars and molar incisor hypomineralisation in patients with cleft lip and/or palate

PURPOSE

This study aimed to determine the prevalence of hypomineralised second primary molars (HSPM) and molar incisor hypomineralisation (MIH) in cleft lip and/or palate (CL/P) patients.

METHODS

A retrospective analysis of intraoral photographs of CL/P patients was done. All patients born between 2000 and 2011, and visiting the cleft team of the Erasmus Medical Center in Rotterdam, The Netherlands, were included. Their photos were scored on the presence and severity of HSPM and MIH using criteria formulated by the European Academy of Pediatric Dentistry. The outcomes were compared with data of the general population, extracted from the Generation R study.

RESULTS

The photos of 535 CL/P patients were evaluated. The overall prevalence of HSPM in CL/P patients was 15.2%, of MIH 12.8%. HSPM and MIH prevalence was significantly higher (both p < 0.001) compared to prevalence in the general population. No significant differences were found in prevalence of HSPM nor of MIH in CL/P patients based on gender (p = 0.891 resp. p = 0.405), cleft type (p = 0.282, resp. p = 0.415), Pierre Robin (p = 0.837, resp. p = 0.169) or other comorbidities (p = 0.553, resp. p = 0.617). CL/P patients with HSPM were almost 3 times more likely diagnosed with MIH than CL/P patients without HSPM (OR = 2.57, p = 0.002).

CONCLUSION

The prevalence of HSPM and MIH is higher in patients with CL/P than in the general population.

Navigating the Complexities of Molar Incisor Hypomineralization: Challenges and Strategies in Pediatric Dentistry

Background: Molar incisor hypomineralization (MIH) presents a multifaceted challenge in pediatric dentistry, impacting diagnostics, clinical management, resource accessibility, and psychosocial care. The condition's complexity is exacerbated by diagnostic variability, overlapping clinical symptoms, and the need for tailored treatment approaches. Objectives: This study aims to explore the key challenges associated with the management of MIH in pediatric dentistry, including diagnostic precision, clinical management, resource limitations, interdisciplinary care, long-term follow-up, and psychosocial impact, and to propose strategies for overcoming these obstacles. Methods: A comprehensive literature review was conducted to identify and synthesize existing evidence on MIH's etiology, diagnosis, treatment, and prognosis. The review highlighted the barriers encountered in providing optimal care, particularly in resource-constrained settings, and explored potential solutions through clinical and interdisciplinary approaches. Results: The key findings included the need for standardized diagnostic criteria, the role of individualized treatment plans, and the importance of resource allocation. Limited access to specialized equipment and education hampers care, especially in under-resourced areas. Long-term management complexities were further compounded by the necessity for interdisciplinary collaboration and attention to psychosocial factors affecting pediatric patients. Conclusion: Effective MIH management requires standardized diagnostic protocols, resource advocacy, interdisciplinary collaboration, and holistic patient care. Advancements in research, education, and policy are essential to improve outcomes in pediatric patients. By addressing both clinical and psychosocial challenges, the overall well-being of MIH-affected children can be enhanced.

Association between molar incisor hypomineralisation and tooth agenesis: a cross-sectional study in Brazilian children and adolescents

PURPOSE

The aim of the present was to assess the association between MIH and tooth agenesis (TA) in orthodontic patients from the Federal University of Rio Grande do Norte, Natal, Brazil.

METHODS

A cross-sectional study was performed to evaluate the presence of MIH and TA in a sample of 371 pretreatment orthodontic records from patients aged 9-18 years. Statistical analyses were performed using the Chi-square and Fisher's exact tests, and logistic regressions.

RESULTS

There was a statistically significant association between the prevalence of tooth agenesis and MIH. A higher percentage of third molar agenesis, maxillary premolar agenesis, and mandibular second premolar agenesis was observed among children with MIH-affected teeth. Patients with MIH had a 2.43 times greater chance of third molar agenesis, and a 5.88 times higher likelihood of mandibular premolar agenesis.

CONCLUSION

There is a weak association between MIH and TA. Furthermore, the presence of hypomineralised molars increases the risk of tooth agenesis.

Molar Incisor Hypomineralization: A Survey of Dental Students from Polish Medical Universities

BACKGROUND

Molar incisor hypomineralization (MIH) is a congenital qualitative disorder of the enamel tissue. During examinations, clinicians may observe a range of enamel opacities during examinations. The aim of this study was to assess the knowledge and awareness of dental students in Poland regarding MIH.

METHODS

This study was conducted among dental students who participated in scientific conferences for dental students in Poland. An electronic questionnaire was created for this purpose, accessible via a QR code.

RESULTS

The respondents consisted of dental students from the first to the fifth year of study, including 98 fourth-year students and 76 fifth-year students. The students represented 10 medical universities in Poland. Of the 341 respondents, 256 (75.07%) stated that they were familiar with the term MIH, but only 61 (17.89%) correctly indicated the diagnostic criteria of MIH. The most frequently indicated condition resembling MIH was enamel hypoplasia, with 158 (46.33%) respondents identifying it.

CONCLUSIONS

Dental students at Polish medical universities have basic knowledge of MIH, but it is insufficient and needs to be improved during their educational training.

Molar Incisor Hypomineralization: Etiology, Correlation with Tooth Number Anomalies and Implications for Comprehensive Management Strategies in Children from Transylvania

BACKGROUND/OBJECTIVES

This study investigates the etiology of enamel developmental defects, specifically Molar Incisor Hypomineralization (MIH), and explores correlations between MIH and dental anomalies such as hypodontia to improve interdisciplinary restorative and orthodontic treatments. Additionally, it assesses the influence of stress factors on the development of enamel defects.

METHODS

Conducted from July to September 2024, this study involved 57 patients aged 6 to 11 from an urban setting, divided into two groups: 32 with MIH and 25 controls, selected based on criteria of mixed dentition without systemic pathology or chronic medication. Clinical evaluations, including intraoral photographs and panoramic radiographs, were performed alongside a detailed questionnaire addressed to the mothers covering prenatal, perinatal, and postnatal factors.

RESULTS

The average age of children with MIH was 7.5 years, in contrast to 7.04 years in the control group (p = 0.17). Significant differences were noted in maternal age, with MIH mothers older (35.56 years) than controls (29.36, p = 0.0001). The prevalence of MIH was higher in boys (66.7%) compared to girls (38.1%, p = 0.036). Factors such as prolonged labor, medication during birth, and early postnatal medication were significantly linked to MIH. The study shows a strong correlation with hypodontia, with a significantly higher incidence of tooth number anomalies (p = 0.009) in the study group.

CONCLUSIONS

Overall, the study emphasizes the association of MIH with various maternal and birth-related factors and with hypodontia, highlighting the need for a comprehensive, multidisciplinary approach to diagnosis and treatment. Further research is recommended to investigate the relationship between stress factors and MIH.

Diagnosing celiac disease in children using oral manifestations

PURPOSE

Celiac disease (CD) may be frequently undiagnosed due to the absence of characteristic gastroenterologic symptoms in many CD patients. Our objective was to diagnose CD by utilizing documented oral manifestations such as Recurrent Aphthous Stomatitis (RAS) and Molar-Incisor Hypomineralization (MIH).

METHODS

The study comprised sixty children who presented with complaints of RAS lesions. The MIH group consisted of 40 children, while the control group comprised 20 children without MIH lesions, ranging in age from 7 to 13 years. After the dental examination, all children were given a questionnaire to assess whether they had any previous history of general symptoms related to CD. Following that, diagnostic testing for celiac disease were conducted, including serological tests such as Tissue transglutaminase IgA (tTG-IgA), Endomysium Antibody (EMA), and Total IgA, as well as genetic tests for HLA-DQ2 and HLA-DQ8.

RESULTS

The statistical analysis, conducted using Fisher's Exact, Yates' Continuity Correction, Fisher Freeman Halton, and Student's t tests, revealed no significant differences between the groups (p < 0.05). Within the MIH group, 3 children exhibited border tTG-IgA values, while another 3 had positive tTG-IgA results. Two of these 6 children had also positive EMA and HLA results. Following a biopsy procedure, these two children were ultimately diagnosed with celiac disease (CD).

CONCLUSIONS

In this study, while children initially presented to the clinic with complaints of recurrent aphthous stomatitis (RAS), 2 children (5% of the MIH group) were diagnosed with CD shortly after the onset of MIH lesions. CD enhanced the likelihood of observing some oral manifestations particularly recurrent aphtous stomatitis and developmental enamel defects. We recommend that dentists be cautious about diagnosing CD when RAS lesions and DEDs and/or MIH lesions are present, whether or not other indications of this systemic disease exist.

Awareness of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPMs) among Northern Italian Dentists: A Questionnaire Survey

BACKGROUND

The purpose of this study was to assess the awareness of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPMs) among dental practitioners in Northern Italy, and to gather data on the occurrence of these conditions in their paediatric patients.

METHODS

A cross-sectional study was conducted using a structured online questionnaire administered through Google Forms. The survey comprised 10 single-choice questions addressing the occurrence of MIH and HSPM in caries-free patients aged 6-9 years.

RESULTS

A total of 315 dentists participated in the survey, yielding a response rate of 31.5%. The majority of respondents reported that 1-25% of their paediatric patients exhibited HSPMs. Among this group, 43.62% of respondents observed MIH in 1-25% of cases.

CONCLUSION

The findings from this survey suggest a consistent perception of MIH and HSPMs among dental practitioners, aligning with known prevalence data and indicating recognition of these conditions within the dental community in Northern Italy.

Molar incisor hypomineralization: Prevalence, severity and associated aetiological factors in children seeking dental care at Armed Forces Hospital Jazan, Saudi Arabia

Background

The prevalence of molar incisor hypomineralisation (MIH) varies worldwide. In Saudi Arabia, data about this condition is limited to a few cities.

Aim

To evaluate the prevalence, severity and associated aetiological factors of MIH in children seeking dental care in Armed Forces Hospital, Jazan, Saudi Arabia.

Methodology

Participants were recruited by convenience sampling according to eligibility criteria. Diagnostic criteria used were according to the molar incisor hypomineralisation severity scoring system (MIH-SSS). Demographic data and past medical history were recorded using a carefully organised questionnaire, and MIH causal factors were evaluated.

Results

A total of 1405 children participated in the study. Among the permanent first molars, mandibular teeth were more frequently affected by MIH than maxillary teeth. In the permanent central incisors group, maxillary teeth were more frequently involved than mandibular teeth, whereas lateral incisor was the least affected among the tooth types in all four quadrants. MIH had more frequently involved all four molars (66.1%), and two associated central incisors were found (31.3%). MIH in the incisors had mild to moderate severity, whereas molars presented with severe defects. Among prenatal factors, maternal anaemia and vitamin D deficiency, out-of-perinatal factors, caesarean delivery, low birth weight and perinatal jaundice, and early childhood tonsillitis and early childhood anaemia were the significant associated factors for MIH development.

Conclusion

The prevalence of MIH was 8%, and maxillary incisors and mandibular first molars were frequently affected. Children with MIH showed prenatal, perinatal and postnatal aetiological factors involved in the development of MIH.

Oral Health and Caries Prevention: How Tongue Hygiene Helps Maintain Balance of Microbiota and Overall Health in Pediatric Patients

BACKGROUND/OBJECTIVES

The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS).

METHODS

An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time.

RESULTS

Four randomized trials met the search criteria and were included in this review.

CONCLUSIONS

The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research.

Potential Association of Molar-Incisor Hypomineralization (MIH) with Dental Agenesis and Infraoccluded Deciduous Molars: Is MIH Related to Dental Anomaly Pattern (DAP)? An Observational Cross-Sectional Study

Background: Dental Anomaly Pattern (DAP) is a collection of morphologic, numeric, and eruptive anomalies of teeth that are often observed together, suggesting a potential genetic relationship. Our objective was to assess the potential associations of Molar-Incisor Hypomineralization (MIH), a common developmental defect of enamel mineralization with a controversial etiology, with two specific components of DAP: (1) agenesis (AG) and (2) infraoccluded deciduous molars (IODM). Establishing such an association between MIH and one or both anomalies would provide evidence supporting a genetic link between MIH and DAP. Methods: We examined pretreatment intraoral standardized photographies and panoramic radiographs from 574 children aged 8-14 years, 287 having MIH and 287 without MIH, comparing the frequencies of AG and IODM in both groups. The subject samples were sourced from the databases of the orthodontic department at a university hospital. Results: The frequencies of AG in the MIH and non-MIH groups were 7% and 8%, respectively (p = 0.751). The corresponding frequencies of IODM were 27% and 19.2%, respectively (p = 0.082). That is, children with MIH did not exhibit an increased frequency of AG or IODM compared to those without MIH. Conclusions: These findings do not support the inclusion of MIH in DAP. Nevertheless, further analysis of possible associations is necessary to definitively validate or invalidate this hypothesis.

Association of Three Genetic Loci with Molar Incisor Hypomineralization in Polish Children

BACKGROUND

Molar incisor hypomineralization (MIH) is a qualitative, demarcated enamel defect of hypomineralization affecting one to four first permanent molars, often with incisor involvement. Its etiology is complex. However, evidence suggests the influence of genetic factors, potentially including the single nucleotide polymorphisms (SNPs) rs2889956, rs4811117 and rs13058467, which were previously linked to MIH in a genome-wide association study of German children. The aim was to replicate analyses of possible associations between the SNPs and molar incisor hypomineralization in Polish children.

METHODS

The final study group consisted of 778 children aged 126-168 months old. Saliva samples were taken, and genomic DNA was extracted and genotyped using beadchip microarrays.

RESULTS

Among the 778 subjects, there were 68 (8.7%) subjects with MIH and 710 (91.3%) subjects without MIH. There were no significant differences in distributions in age, sex, or the frequency of caries in permanent dentition between the MIH and non-MIH groups. The rs2889956, rs4811117, and rs13058467 genotype distributions in the studied group conformed to the expected Hardy-Weinberg equilibria, and there were no significant differences in the distributions of their alleles or genotypes between the MIH and non-MIH groups.

CONCLUSION

Our replication study did not confirm highly significant associations between the single nucleotide polymorphisms rs2889956, rs4811117, and rs13058467 with molar incisor hypomineralization in Polish children.

Relationship between cariogenic bacteria and molar incisor hypomineralization in Brazilian schoolchildren

Background

Teeth with defects in their structure, such as the ones affected by molar-incisor hypomineralization (MIH), are more susceptible to carious lesions. Caries is a complex and multifactorial disease highly prevalent in childhood. The present research evaluated the relationship between the stages of MIH and cariogenic bacteria in children.

Methods

After examining 566 schoolchildren, four groups of 10 children each were formed: healthy (G1), mild MIH (G2 and G3), and severe MIH + caries (G4). Dental biofilm was assessed to quantify Streptococcus mutans (SM) and Lactobacillus spp. (LB) using real-time polymerase chain reaction (RT-PCR).

Results

LB counting in biofilm samples of healthy children (G1) and those with mild MIH characterized by white opacities (G2) were not significantly different. The same happened when the ones with yellow opacities (G3) were compared with severe MIH + caries (G4) (P>0.05). The post hoc Tukey test proved that G4 had greater levels of SM and LB when compared with G2 (P<0.05); however, the control group did not diverge from the others considering SM (P>0.05). Increased LB enhanced the severity of MIH [rate ratio (RR): 7.706; P=0.035].

Conclusions

LB was influenced by different degrees of MIH and the presence of caries and could guide clinical decisions and patients' recommendations to prevent carious lesions in MIH children.

Biomimetic hydroxyapatite paste for molar-incisor hypomineralization: A randomized clinical trial

OBJECTIVES

The aim of this randomized clinical trial was to evaluate the desensitizing and remineralizing effect of a new zinc-hydroxyapatite-based paste in sites affected by molar-incisor hypomineralization (MIH), by assessing dental sensitivity, tooth wear, and periodontal indexes.

MATERIALS AND METHODS

Twenty-five patients with presence of 1 enamel demineralization of permanent molars and incisors in two different quadrants were recruited. After professional dental hygiene, a domiciliary hydroxyapatite-based paste was assigned and recommended to be applied on 2 MIH teeth in one random quadrant (test group), while the 2 contralateral MIH teeth did not undergo paste application (control group). The following primary outcomes were assessed: Plaque Control Record (PCR), Bleeding Index (BI), MIH Treatment Need Index (MIH-TNI), and Schiff Air Index (SAI).

RESULTS

No significant inter- and intragroup differences were found for PI and BI, except for both intragroup T0-T1. For MIH-TNI, significant intergroup differences were detectable in the test group after 9 months of treatment. For SAI values, no significant differences were found in the control group, while in the test group, significant lower values were found after 1 and 3 months since baseline, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Biomimetic zinc-hydroxyapatite showed a desensitizing effect when used to treat MIH.

Asthma medication and risk of dental diseases in children - A prospective cohort study

BACKGROUND

Dental caries and enamel defects are the main causes of poor dental health in children, with a substantial impact on their well-being. Use of inhaled asthma medication is a suspected risk factor, but there is a lack of prospective studies investigating this and other prenatal and early life risk factors.

METHODS

Copenhagen Prospective Studies on Asthma in Childhood 2010 mother-child cohort (COPSAC2010 ) consists of 700 women who were recruited at 24 weeks of pregnancy. 588 of their children participated in a dental examination at 6 years of age (84%) at the COPSAC2010 research unit. Caries was defined as decayed, missing, or filled surfaces. Enamel defect was defined as demarcated opacity, post-eruptive enamel breakdown, and/or atypical restoration on at least one molar. Caries and enamel defects were assessed in both deciduous and permanent dentitions.

RESULTS

We found no associations between inhaled corticosteroids or β2 -agonists or asthma symptoms in early childhood and the risk of caries or enamel defects by 6 years of age. Furthermore, we found no strong pre-, peri-, or postnatal risk factors for dental diseases at 6 years, except from nominally significant associations between antibiotic use in pregnancy (OR = 1.25, [1.01-1.54]), maternal education level (OR = 1.57, [1.01-2.45]), having a dog at home (OR = 0.50, [0.27-0.93]), and risk of enamel defects.

CONCLUSIONS

Use of inhaled corticosteroids, β2 -agonists, or asthma symptoms in the first 6 years of life were not associated with the development of caries or enamel defects. This finding is reassuring for parents and physicians prescribing asthma medication for young children.

Genetic Factors of Teeth Impaction: Polymorphic and Haplotype Variants of PAX9, MSX1, AXIN2, and IRF6 Genes

In recent research, there has been a growing awareness of the role of genetic factors in the positioning and eruption of teeth in the maxilla and mandible. This study aimed to evaluate the potential of specific polymorphic markers of single nucleotide polymorphisms (SNPs) located within the PAX9, MSX1, AXIN2, and IRF6 genes to determine the predisposition to tooth impaction. The study participants were divided into two groups: the first group consisted of individuals with at least one impacted secondary tooth. In contrast, the second group (control group) had no impacted teeth in their jaws. To analyze the genes, real-time PCR (polymerase chain reaction) and TaqMan probes were utilized to detect the selected polymorphisms. The findings suggest that disruptions in the structure and function of the mentioned genetic factors such as polymorphic and haplotype variants of PAX9, MSX1, AXIN2, and IRF6 genes, which play a direct role in tooth and periodontal tissue development, might be significant factors in tooth impaction in individuals with genetic variations. Therefore, it is reasonable to hypothesize that tooth impaction may be influenced, at least in part, by the presence of specific genetic markers, including different allelic variants of the PAX9, AXIN2, and IRF6 genes, and especially MSX1.

Predictive Value of Hypomineralization of Second Primary Molars for Molar Incisor Hypomineralization and Other Relationships between Both Developmental Defects of Dental Enamel

Molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM) are dental enamel developmental defects with significant prevalence and psychophysical impact, posing a public health concern. We examined the relationship between HSPM and MIH in 426 children aged 7 to 10 years (213 with MIH, 213 without MIH). The frequency of HSPM was higher in children with MIH (37.1% vs. 11.3%, p < 0.001). However, there was no correlation between MIH severity and presence of HSPM (p = 0.296). In patients with both defects (n = 79), 90% of severe MIH cases were associated with severe HSPM, while 87.8% of mild MIH cases were associated with mild HSPM (p < 0.001). The involvement of permanent incisors by MIH was not influenced by the presence of HSPM or HSPM severity. HSPM exhibited a positive predictive value of 76.7, negative predictive value of 58.8, sensitivity of 37.1% (95% CI = 30.6-43.6%), and specificity of 88.7% (95% CI = 84.5-93%). The odds ratio for MIH based on HSPM was 4.64 (95% CI). HSPM may serve as a predictor of MIH, but its absence does not rule out the occurrence of MIH. The results highlight the need for surveillance programs in children presenting with HSPM to facilitate early diagnosis and preventive measures for MIH-related complications.

Effectiveness of Cyanoacrylate in the Treatment of Dentin Hypersensitivity: A Systematic Review

Objective

To compare the effectiveness of cyanoacrylate to other treatments or placebo in the management of dentin hypersensitivity (DH).

Materials and Methods

The present review was organized based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The search aimed to answer the following question: is cyanoacrylate effective in the treatment of DH when compared to other treatments or placebo? The following databases were used: PubMed/MEDLINE, Scopus, BVS, Web of Science, Cochrane, Clinicaltrials.gov, Portal Periódicos Capes, Google Scholar, and manual search. The evaluation process started with the information collected from the selected articles according to the Consolidated Standards of Reporting Trials (CONSORT).

Results

Two randomized and five nonrandomized clinical trials were analyzed in the qualitative synthesis. The studies presented different cyanoacrylate formulations, different scales for evaluating pain, and different methods for provoking a painful stimulus. Cyanoacrylate-based products reduce DH in shorter follow-up periods and this reduction persisted throughout the study. The results varied according to the methods used to stimulate the pain. Only two articles showed a low risk of bias and a high level of scientific evidence.

Conclusion

Although there is a limited number of studies in the scientific literature with appropriate methodological quality, the available evidence proves the effectiveness of cyanoacrylate in the treatment of DH. Clinical Relevance. Cyanoacrylate is easy to access, effective, easily applicable, and a low-cost product with satisfactory results.

Contemporary Understanding of the Etiology and Management of Molar Incisor Hypomineralization: A Literature Review

Molar incisor hypomineralization (MIH) is a significant health problem that can affect the child's quality of life by negatively affecting their esthetics and function. This review aimed to summarize the etiology and pathogenesis of MIH. It also aimed to summarize the recent studies on MIH in children and adolescents, focusing on diagnosis, prevention, and clinical management. An electronic search on the PubMed, Cochrane Database of Systematic Reviews, MEDLINE, MedlinePlus, WHO reports, and Google Scholar databases was performed. The volume of research on the etiology, presentation, and clinical management of MIH is still expanding. The creation and validation of indices for the diagnosis and management of MIH, as well as any potential genetic aspects appear to be the main areas of current research. Notably, MIH was linked to childhood illnesses, the use of antibiotics, and early childhood fever. Although many studies discuss the different options for managing MIH lesions, evidence-based studies that address the long-term outcomes of MIH are still lacking. Indeed, future clinical studies should be directed to evaluate the impact of each systemic etiological factor and its different types of management on normal amelogenesis. Regarding the diagnosis, future research should focus on the pre-eruption diagnosis and early approaches to prevent the post-eruption breakdown and caries. Regarding the treatment of MIH, future investigations should emphasize further improvements in adhesion and the use of new materials and techniques, such as digital dentistry.

Association between genetic factors and molar-incisor hypomineralisation or hypomineralised second primary molar: A systematic review

OBJECTIVE

To determine the association between genetic factors and molar-incisor hypomineralisation (MIH) and/or hypomineralised second primary molars by means of a systematic review.

DESIGN

A search was performed in Medline-PubMed, Scopus, Embase and Web of Science databases; manual search and search in gray literature were also performed. Selection of articles was performed independently by two researchers. A third examiner was involved in cases of disagreement. Data extraction was performed using an Excel® spreadsheet and independent analysis was performed for each outcome.

RESULTS

Sixteen studies were included. There was an association between MIH and genetic variants related to amelogenesis, immune response, xenobiotic detoxification and other genes. Moreover, interactions between amelogenesis and immune response genes, and SNPs in the aquaporin gene and vitamin D receptors were associated with MIH. Greater agreement of MIH was found in pairs of monozygotic twins than dizygotic twins. The heritability of MIH was 20 %. Hypomineralised second primary molars was associated with SNPs in the hypoxia-related HIF-1 gene and methylation in genes related to amelogenesis.

CONCLUSION

With very low or low certainty of evidence, an association was observed between MIH and SNPs in genes associated with amelogenesis, immune response, xenobiotic detox and ion transport. Interactions between genes related to amelogenesis and immune response as well as aquaporin genes were associated to MIH. With very low certainty of evidence, hypomineralised second primary molars was associated to a hypoxia-related gene and to methylation in genes related to amelogenesis. Moreover, higher agreement of MIH in pairs of monozygotic twins than dizygotic twins was observed.

Cross-Cultural Validity of a Dietary Questionnaire for Studying Dental Caries in Japanese Children

This study examines the cross-cultural validity of the Japanese version of the Food Frequency Questionnaire (FFQ), designed for studies on dental caries to assess dietary intake in Japanese children. Parent-reported dietary data were collected (274 children, 3-6 years old) using the 38-item FFQ, whose reliability and validity have been demonstrated in adults. Factor analysis was used to determine dimensionality. Dietary cariogenicity scores were compared with the levels of plaque mutans streptococci, and the decayed, missing, and filled teeth (dmft) index to evaluate the criterion validity using Pearson's correlation coefficient (r) and the Kruskal-Wallis test. The FFQ showed good criterion validity, assessed through its relationship with the dmft index (r = 0.119; p = 0.05) and Dentocult SM score (r = 0.124; p = 0.04). Factor analysis revealed six questionnaire subscales. Internal consistency was from low to acceptable (Cronbach's alpha = 0.64 for the total scale, 0.39-0.53 for each subscale). Children with a higher SM score were more likely to have higher dietary cariogenicity scores (p = 0.01; Kruskal-Wallis test). These results confirm the validity of the Japanese version of the FFQ for children, which can be used to track dietary structure dynamics regarding cariogenicity from childhood to adulthood.

Heterozygous Variants in FREM2 Are Associated with Mesiodens, Supernumerary Teeth, Oral Exostoses, and Odontomas

BACKGROUND

Supernumerary teeth refer to extra teeth that exceed the usual number of dentitions. A mesiodens is a particular form of supernumerary tooth, which is located in the premaxilla region. The objective of the study was to investigate the genetic etiology of extra tooth phenotypes, including mesiodens and isolated supernumerary teeth.

METHODS

Oral and radiographic examinations and whole-exome sequencing were performed on every patient in our cohort of 122 patients, including 27 patients with isolated supernumerary teeth and 94 patients with mesiodens. A patient who had multiple supernumerary teeth also had odontomas.

RESULTS

We identified a novel (c.8498A>G; p.Asn2833Ser) and six recurrent (c.1603C>T; p.Arg535Cys, c.5852G>A; p.Arg1951His, c.6949A>T; p.Thr2317Ser; c.1549G>A; p.Val517Met, c.1921A>G; p.Thr641Ala, and c.850G>C; p.Val284Leu) heterozygous missense variants in FREM2 in eight patients with extra tooth phenotypes.

CONCLUSIONS

Biallelic variants in FREM2 are implicated in autosomal recessive Fraser syndrome with or without dental anomalies. Here, we report for the first time that heterozygous carriers of FREM2 variants have phenotypes including oral exostoses, mesiodens, and isolated supernumerary teeth.

White Spot Lesions (WSLs)-Post-Orthodontic Occurrence, Management and Treatment Alternatives: A Narrative Review

Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords "white spot lesions", "orthodontics", "WSL", "enamel" and "demineralization" in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito.

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.

Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review

The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.

Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students’ knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented.

Method Presentation of a New Integrated Orthodontic-Conservative Approach for Minimally Invasive Full Mouth Rehabilitation: Speed Up Therapy

The materials available today allow for extensive oral rehabilitations in a non-invasive way, and often an orthodontic preparation is useful and, thanks to the use of clear aligners, is predictable and comfortable. A preliminary study of the wax-up, mock-up, and set-up allow the clinician to plan every aspect of the treatment in detail. Furthermore, the procedure offers the patient an intuitive and understandable view of the expected final result. The new proposed method, called “speed up therapy”, allows for the integration of the orthodontic set-up with the mock-up technique, simulating the occlusal and aesthetic components of the planned restoration, in all details. The clinical case presented, demonstrates step by step the predictability and clinical reliability of the proposed procedure. The final clinical result coincides exactly with the initial mock-up and demonstrates that the proposed method is predictable and reliable. The correct execution of the technique is rigorously customized, and its success is operator dependent, both for the clinical aspects and for the dental laboratory. Thus, the visualization of the objectives of the treatment constitutes a decisive support for the clinician and provides the patient with the possibility of benefiting from an immediate improvement by making it easier for them to accept a treatment plan. The visualization also includes an orthodontic phase that potentially lengthens the treatment but makes the realization more conservative and predictable.

Evaluation of the Efficacy of CPP-ACP Remineralizing Mousse in MIH White and Yellow Opacities-In Vitro Vickers Microhardness Analysis

Remineralization of tooth enamel can be partially achieved by the application of a casein phosphopeptides and amorphous phosphate (CPP-ACP) complex. However, evidence to support its effectiveness in Molar-incisor-hypomineralization (MIH)-affected teeth is scarce. The study’s aim is to evaluate the efficacy of CPP-ACP mousse in remineralizing MIH-affected enamel using a Vickers microhardness test. Two groups of enamel opacities of hypomineralized permanent teeth, white (group A) and yellow (group B) lesions (n = 14), went through a 28-day treatment protocol with GC Tooth Mousse. Before and after treatment, microhardness was measured in three different areas of each tooth (hypomineralized, transition, and outside the hypomineralized area). Data were analyzed using parametric and non-parametric tests with a significance of p < 0.05. The mean microhardness values increased in the hypomineralized and transition areas in both groups after the treatment protocol (in group A, 105.38 ± 11.70 to 158.26 ± 37.34; 123.04 ± 22.84 to 156.33 ± 35.70; in group B, 108.63 ± 14.66 to 143.06 ± 22.81; 132.55 ± 20.66 to 146.00 ± 12.88) and the differences pre/post-treatment were statistically significant within each group (p < 0.001 for both groups). Between groups, there was a statistically significant difference in the same areas (hypomineralized: p = 0.003; transition: p = 0.008) with a higher improvement in enamel hardness in group A. Topical application of CPP-ACP showed an increase in the physical strength of the hypomineralized and transition areas of MIH-affected enamel, likely due to an increase in mineral content.

Malocclusions in Pediatric Patients with Asthma: A Case-Control Study

Asthma is a public health problem that has been widely described, but little has been reported about its effects on dental occlusions. The aim of this study was to compare the alterations of normal occlusions in asthmatic children and those without the disease. The study included 186 patients between 5 and 12 years old, divided into two groups. The first group included patients with a previous diagnosis of asthma given by a specialist, which was confirmed by using the International Study of Asthma and Allergies in Childhood questionnaire. The second group included patients without the disease. All patients underwent a clinical examination to determine the presence of occlusion alterations in the sagittal, transverse, and vertical planes. Subsequently, chi-squared tests were performed to compare the variables between the groups. A significant association was found between asthma and the variables studied here: alterations in the sagittal plane (chi2 = 7.839, p = 0.005), alterations in the vertical plane (chi2 = 13.563, p < 0.001), alterations in the transverse plane (Fisher’s F p < 0.001), and oral habits (chi2 = 55.811, p < 0.001). The results suggest that asthmatic patients are more likely to develop malocclusions, especially anterior open bite and posterior crossbite. These conditions are typically related to mouth breathing, which is common in asthmatic patients.

Prevalence and Possible Etiological Factors of Molar-Incisor Hypomineralization (MIH) in Population of Silesian Children in Poland: A Pilot Retrospective Cohort Study

(1) Background: This pilot retrospective cohort research study regarded the frequency of the prevalence of molar-incisor hypomineralization (MIH) in a population of Silesian children in Poland. The evaluation of the potential environmental etiological factors was performed and the correlation between the environmental factors and MIH was analyzed. (2) Methods: A total of 613 children were randomly enrolled in the pilot study (9.0 years ± 1.9). A survey was carried out with mothers regarding the potential exposure to environmental etiological factors of MIH in their children. The patients’ clinical assessments were carried out in the dental unit. (3) Results: The frequency of prevalence of MIH in the population of Silesian children was established at the level of 6.2% (p < 0.05). MIH symptoms were significantly associated with otitis in early childhood (OR = 2.50), atopic dermatitis (OR = 5.69), and premature delivery before 38 weeks of pregnancy (OR = 2.88). (4) Conclusions: MIH was observed in 6.2% of the population of Silesian children, and there was a relationship between environmental risk factors such as otitis, atopic dermatitis, premature birth, and MIH expression. Therefore, further research is needed to determine the influence of pre-, peri-, postnatal, and prophylactic factors on the frequency and severity of MIH symptoms in children.

Oralbiotica/Oralbiotics: The Impact of Oral Microbiota on Dental Health and Demineralization: A Systematic Review of the Literature

The oral microbiota plays a vital role in the human microbiome and oral health. Imbalances between microbes and their hosts can lead to oral and systemic disorders such as diabetes or cardiovascular disease. The purpose of this review is to investigate the literature evidence of oral microbiota dysbiosis on oral health and discuss current knowledge and emerging mechanisms governing oral polymicrobial synergy and dysbiosis; both have enhanced our understanding of pathogenic mechanisms and aided the design of innovative therapeutic approaches as ORALBIOTICA for oral diseases such as demineralization. PubMed, Web of Science, Google Scholar, Scopus, Cochrane Library, EMBEDDED, Dentistry & Oral Sciences Source via EBSCO, APA PsycINFO, APA PsyArticles, and DRUGS@FDA were searched for publications that matched our topic from January 2017 to 22 April 2022, with an English language constraint using the following Boolean keywords: ("microbio*" and "demineralization*") AND ("oral microbiota" and "demineralization"). Twenty-two studies were included for qualitative analysis. As seen by the studies included in this review, the balance of the microbiota is unstable and influenced by oral hygiene, the presence of orthodontic devices in the oral cavity and poor eating habits that can modify its composition and behavior in both positive and negative ways, increasing the development of demineralization, caries processes, and periodontal disease. Under conditions of dysbiosis, favored by an acidic environment, the reproduction of specific bacterial strains increases, favoring cariogenic ones such as Bifidobacterium dentium, Bifidobacterium longum, and S. mutans, than S. salivarius and A. viscosus, and increasing of Firmicutes strains to the disadvantage of Bacteroidetes. Microbial balance can be restored by using probiotics and prebiotics to manage and treat oral diseases, as evidenced by mouthwashes or dietary modifications that can influence microbiota balance and prevent or slow disease progression.

Is Aberrant DNA Methylation a Key Factor in Molar Incisor Hypomineralization?

Molar incisor hypomineralization (MIH) is a qualitative disturbance of the enamel of the permanent molars and/or incisors. Its etiology is not clearly defined but is connected with different factors occurring before and after birth. It remains difficult to identify a single factor or group of factors, and the problem is further complicated by various overlapping mechanisms. In this study, we attempted to determine whether DNA methylation-an epigenetic mechanism-plays a key role in the etiology of MIH. We collected the epithelium of the oral mucosa from children with MIH and healthy individuals and analyzed its global DNA methylation level in each child using a 5-mC DNA ELISA kit after DNA isolation. There was no statistically significant difference between the global DNA methylation levels in the study and control groups. Then, we also analyzed the associations of the DNA methylation levels with different prenatal, perinatal, and postnatal factors, using appropriate statistical methods. Factors such as number of pregnancies, number of births, type of delivery, varicella infection (under 3 years old), and high fever (under 3 years old) were significantly important. This work can be seen as the first step towards further studies of the epigenetic background of the MIH etiology.

Relationship between molar incisor hypomineralization, intrapartium medication and illnesses in the first year of life

Molar incisor hypomineralization (MIH) affects the first permanent molars and permanent incisors whose formative embryological process develops around birth and the first year of life. This study's main objective is to assess the relationship between MIH, on the one hand, with the administration during childbirth of epidural bupivacaine, intramuscular meperidine with haloperidol, synthetic intravenous oxytocin, and prostaglandins such as dinoprostone vaginally, and on the other hand, with suffered pathologies during the first year of life. Cross-sectional retrospective study was carried out on 111 children who attended dental check-ups. Oral examination was carried out to determine MIH involvement. Data on the administration of medications during delivery and the illnesses suffered by the children in the first year of life were taken from the hospital records. Significant relationship with Pearson's chi-square was found between the presence of MIH and the administration of meperidine with haloperidol intramuscularly and the vaginal administration of dinoprostone during labour. Also in children who have suffered serious infections and those who have received antibiotics in early childhood. In recent years there has been a growing trend in many countries to medicalize childbirth even above what the World Health Organization recommends. Some of the drugs used in these protocols could be involved in the appearance of dental mineralization alterations of the MIH type and this would help to explain the increase in its prevalence.

Pit and Fissure Sealant versus Fluoride Varnish for the Prevention of Dental Caries in School Children: A Systematic Review and Meta-Analysis

Children's dental health has become the main concern, due to the increase in caries prevalence amongst children. Pit and fissure sealant (PFS) and fluoride varnish (FV) are effective measures for preventing dental caries. However, the clinical efficacy of these interventions when compared to one another is uncertain. The aim of the present systematic review with meta-analysis was to compare pit and fissure sealants with fluoride varnish for caries prevention of first permanent molars among schoolchildren. This is a meta-Analysis, which involves randomized control trials that compare the effectiveness of PFS with FV within 24 months of follow-up. Five databases were searched from 1990 to 2019 to identify studies published in Arabic or English language. The risk ratio (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model. A total number of 4 studies were included with overall of 1249 children in both groups. Three included trial reported caries increment of first permanent molars (FPM) with 24 months of follow-up, there was no statistical significance (RR: 0.65; 95% CI 0.31 to 1.35; P = 0.26 I2 = 89%). As regards DMFS increment, the analysis showed no statistical differences between FV and PFS in terms of lowering DMFS increment (MD: 0.09; 95% CI: -0.03 to 0.21). Findings of this meta-analysis proved there is no significant difference between PFS and FV in caries prevention efficacy of FPMs at 2 years' follow-up, emphasizing the use of FV since it is more affordable and easier to apply.

Management of a Hypomineralisation of the Enamel by Applying a Remineraliser Based on Zinc Hydroxyapatite (microRepair)

According to our experience, the treatment with remineralising mousse based on biomimetic nanohydroxyapatite has the advantage of being easily implemented by all patients as it is economical and absolutely noninvasive. The following case report reports the results obtained from the use of a mousse based on biomimetic nanohydroxyapatite for the treatment of incisor and molar hypomineralisation. This case report illustrates the case of a 4-year-old patient who was diagnosed with MIH and was subjected to remineralising treatments at home for six months, at alternating periods. Throughout the observation period, the painful perception of the lesions was detected through an assessment scale, and the clinical appearance was documented photographically. One year after the diagnosis, all the elements involved no longer showed any symptoms.

Hypomineralized Primary Teeth in Preterm Low Birth Weight Children and Its Association with Molar Incisor Hypomineralization—A 3-Year-Prospective Study

The present prospective study was conducted to assess the prevalence of enamel hypomineralization (EH) in primary dentition among preterm low birth weight (PT-LBW) children, incidence of molar incisor hypomineralization (MIH) in the same cohorts, and to determine associations between PT-LBW, hypomineralization in primary second molars, and MIH. A total of 287 PTLBW study subjects and 290 control full-term normal birth weight subjects were followed up for 36 months. Enamel defects were recorded at baseline. The same cohorts were examined after 3 years for MIH using the European Academy of Paediatric Dentistry (EAPD) criteria. Multiple variable logistic regression models were developed. A total of 279 children (48.4%) presented with EH in primary dentition and 207 (35.9%) children presented with MIH. Children with primary second molar hypomineralization had 2.13 (R² = 0.19, 95% CI = 0.98–4.19, p = 0.005) times higher frequency of MIH. Children with PT-LBW had 3.02 times (R² = 0.31, 95% CI = 1.01–5.94, p = 0.005) higher frequency of MIH incidence after adjusting for childhood infection, prenatal history, and presence of hypomineralized primary second molars. To conclude, the present study showed significant association between PT-LBW, hypomineralized second primary molars, and incidence of MIH.