Molar Incisor Hypomineralization Research Articles

Fissure Sealants for Managing Hypersensitivity and Posteruptive Breakdown in MIH-Affected Molars.

Molar incisor hypomineralisation (MIH) is defined as hypomineralisation of systemic origin of one to four first permanent molars with or without the involvement of the permanent incisors. In addition to opacities and posteruptive breakdown, hypersensitivity may be a common problem, especially in the molars. Children then often report that hot and cold drinks and meals, toothbrushing, and even air flow cause pain. Therapy approaches to reduce and stop the hypersensitivity include the sealing of affected teeth. Fissure sealants can be placed in mildly affected molars that show no breakdowns in the occlusal surfaces. Thereby, resin-based sealants can be considered for fully erupted teeth, whereas glass ionomers are the treatment of choice in difficult clinical conditions as an interim treatment where isolation is inadequate and the molar has not fully erupted. The aim of this chapter is to describe the phenomenon of hypersensitivity in MIH-affected teeth, to discuss treatment approaches including the placement of sealants as well as the management of posteruptive breakdowns, and to present data on oral health-related quality of life in children suffering from hypersensitivity.

Prevalence of Enamel Hypomineralisation/Molar Incisor Hypomineralisation: A Scoping Review.

The aim of this scoping review was to provide an up-to-date assessment of the prevalence of enamel hypomineralisation (EH) and, in particular, molar incisor hypomineralisation (MIH). Epidemiological studies published from 2010 to 2023 were analyzed. After screening the primary literature, a total of 139 studies were included. According to the available epidemiological trials of children and adolescents from Europe (n = 39), the average prevalence of EH/MIH was 16.74%. The data from Asian studies (n = 50) showed an average prevalence of 15.6%. For South America (n = 33 studies), the mean prevalence of EH/MIH was 16.7%. The mean prevalence rates for North America (N = 9 studies), Africa (N = 6), and Australia (N = 2) were 25.9%, 11.4%, and 16.8%, respectively. Taken together, these data indicate that EH/MIH is a prevalent condition worldwide. With the aim of standardizing and generating comparable prevalence data, the use of the currently established criteria by the European Academy of Paediatric Dentistry (EAPD) for the detection of EH/MIH may support consistent reporting in epidemiological trials. However, other EH/MIH indices and phenotypes do exist. As the determination of EH/MIH prevalence depends on the correct use of index teeth, meticulous attention must be given to their correct application.

Association of defects of enamel with polymorphisms in the vitamin D receptor and parathyroid hormone genes.

This cross-sectional study aimed to investigate the association between developmental defects of enamel (DDE) and single nucleotide polymorphisms (SNPs) in the genes encoding the vitamin D receptor (VDR) and parathyroid hormone (PTH). Orthodontic patients receiving treatment at a dental school were selected through convenience sampling. Intra-oral photographs were used to assess DDE, which were classified according to the criteria proposed by Ghanim et al. (2015) by a single calibrated examiner (Kappa>0.80). Enamel hypoplasia, molar-incisor hypomineralization (MIH), hypomimineralized second primary molar (HSPM), and non-MIH/HSPM demarcated opacities were considered for the analysis. Genomic DNA was extracted from buccal cells. The SNPs in VDR (rs7975232) and PHT (rs694, rs6256, and rs307247) were genotyped using real-time polymerase chain reactions (PCR). Statistical analyses were performed using the PLINK software (version 1.03, designed by Shaun Purcell, EUA). Chi-square or Fisher's exact tests were performed at a significance level of 5%. Ninety-one (n=91) patients (49 females and 42 males) (mean age of 14.1±5.8 years) were included. The frequency of DDE was 38.5% (35 patients). Genotype distributions were in Hardy-Weinberg equilibrium. No significant statistical association was found between DDE and the SNPs evaluated. A borderline association (p=0.09) was observed between DDE and the CC haplotype for SNP rs7975232 in VDR. In conclusion, the selected SNPs in VDR and PTH genes were not associated with DDE in the studied samples.

Restoration of permanent teeth affected by molar-incisor hypomineralisation

Restoration of permanent teeth affected by molar-incisor hypomineralisation

Different approaches for aesthetic management of molar-incisor hypo-mineralization: two case reports

Background: Molar-incisor hypo-mineralization (MIH) is a developmental enamel defect that affect one or more permanent first molars, with or without incisor teeth involvement. When incisors are affected, that might lead to aesthetic concerns and consequently, negative impact on the child's quality of life. Hence, this study presented and discussed the conservative treatment modalities for maxillary incisors with discolored enamel defects. Case Presentation: Two 12-year-old female patients was referred from pediatric clinics to treat anterior teeth discolorations after management of affected first molars. In the first case, the defect was more heterogenous with yellow-brownish discoloration. To remove yellow-brownish discoloration, in-office bleaching with 37% hydrogen peroxide was performed, followed by home bleaching with 10% carbamide peroxide for one week. Then, resin infiltration (RI) was performed to seal the porous enamel and to mask the white enamel defects. In the second case, the white opacities were more homogenous, therefore, only RI treatment was applied. Conclusion: Aesthetic management of MIH patients should follow more conservative approaches like dental bleach systems and resin infiltration.

Cost-Effectiveness of Managing MIH Teeth.

Numerous therapeutic approaches are available for managing molar incisor hypomineralisation (MIH); however, the cost-effectiveness of these strategies is underexplored. Economic evaluations are crucial for determining the optimal treatment approach to individual patients' requirements. We systematically reviewed the literature on the topic to have a more comprehensive discussion about these issues. Systematic searches were carried out. After a two-stage selection, 11 studies were included for synthesis. These studies could be divided into three groups according to the type of information given on costs: assumptions or deductions based on the literature (n = 6), cost collection on the available sources (n = 3), and cost-effectiveness evaluations (n = 2). The economic evidence on MIH management is still scarce and incipient. However, some important findings were produced for this evidence synthesis. A database of costs valuable in different contexts for therapeutic approaches related to MIH and its consequences was created. Furthermore, compiling and digesting the evidence on the cost-effectiveness of different approaches for managing severe MIH cases points out possible directions to be considered in decision-making that should consider these economic outcomes in different contexts and their powers of generalizability and also other aspects of evidence-based practice (e.g., professional and patients' preferences). Finally, there is an imminent need for economic evaluations focused on investigating the potential efficiency of preventive approaches for managing minor-compromised MIH teeth to postpone/avoid the severe consequences, which are more critical, complex, and costly to treat.

Short-term Results of the Masking Effect of an Infiltrant Resin on Mild Molar Incisor Hypomineralization Lesions in Anterior Teeth.

This non-controlled clinical study evaluated the masking effect of an infiltrant resin on mild molar incisor hypomineralization (MIH) lesions. Thirty MIH-affected anterior teeth with creamy/ white opacities from 12 children aged 6-15 years received the application of an infiltrant resin (Icon- DMG). Standard photographs were taken before (T1), immediately after (T2), and 1 week after (T3) resin infiltration. Two calibrated examiners qualitatively analyzed the color match using the Fédération Dentaire Internationale (FDI) scale. The binomial distribution test analyzed the scores of the color match at T1 with T2 and T3, and McNemar's test analyzed the scores of the color match between T2 and T3 (α=0.05). There was a significant increase in color match between T1 and T2 (p=0.0005), between T1 and T3 (p=0.0005), and between T2 and T3 (p=0.0019). It was concluded that infiltrant resin was effective in improving the esthetic appearance of creamy/white opacities on MIH-affected anterior teeth.

Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Brazilian Schoolchildren Aged 8 to 10 Years

Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Brazilian Schoolchildren Aged 8 to 10 Years

Molar Incisor Hypomineralisation Patient Assessment: Comprehensive Oral, Clinical Records and Behavior Evaluation.

Comprehensively evaluating molar incisor hypomineralisation (MIH) involves the integration of anamnesis and clinical data to diagnose, create a care plan, and predict prognoses. Anamnesis reveals relationships between defects and time, patient expectations, and impacts on the quality of life. Clinical studies emphasize posteruptive breakdown in yellow-brown opacities, highlighting the importance of identifying risk factors. The classification and recording of the clinical features associated with MIH are essential and allow for the longitudinal follow-up of the patient. Assessment of dental caries lesions, oral hygiene, and pain guides the care plan. Depending on the severity of MIH and associated symptoms, intraoral radiographs and cone beam computed tomography may be necessary. In cases of scheduled extractions, extraoral radiographs, photographs, and study models are indicated. Evaluations of the quality of life, aesthetic perception, and dental fear and anxiety provide valuable insights into the patient's emotional status and guide empathetic practice. A positive dental experience is based on communication with the patient, trust, and the proper use of behavior guidance techniques.

Challenges of Using Scoring Systems for the Assessment of Molar Incisor Hypomineralisation.

The dental professional is exposed to complex challenges daily, posed by molar incisor hypomineralisation (MIH). These range from understanding its etiology through to determining the most effective strategies for clinical management of the problem. Beyond any doubt, the choice of the diagnostic scoring system to be used for recording the condition is included among these challenges. To a certain degree, this is understandable since the development of specific diagnostic tools for recording the occurrence of MIH takes place parallel to the ongoing discoveries about the problem. Therefore, the aim of this chapter is to present different MIH scoring systems that have previously been proposed in the literature for detecting MIH and discuss their applications, advantages, and limitations.

Enhancing pediatric comfort: a comprehensive approach to managing molar-incisor hypomineralization with preemptive analgesia and behavioral strategies

Enhancing pediatric comfort: a comprehensive approach to managing molar-incisor hypomineralization with preemptive analgesia and behavioral strategies

Clinical Performance of Two CAD/CAM Fabricated Ceramic Restorations with Different Designs for MIH Rehabilitation: A Randomized Controlled Trial

Background: Molars affected with severe molar incisor hypomineralisation (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. Objective: A randomized clinical trial evaluated the clinical performance of two CAD/CAM fabricated ceramic restorations, Vita Suprinity (VS) and Vita Enamic (VE), with different preparation designs, occlusal veneer and endocrown, for rehabilitation of the first permanent molar affected by MIH. Materials and Methods: The study was registered with NCT05434884 clinical trial ID with 68 patients ranging from 8 to 13 years old, who attended the dental clinic of Al-Azhar University, Girls Branch, and suffering from a severe form of molar incisor hypomineralization. The patients were divided equally into two groups, group I, i.e., occlusal veneer (OV) group, and group II, i.e., endocrown (EN) group, according to different preparation designs related to different severity levels of first permanent molars’ hypomineralization (moderate and severe); each group was subdivided equally and randomly into two subgroups, subgroup A, i.e., Vita Suprinity (VS), and subgroup B, i.e., Vita Enamic (VE), according to the material used for fabrication of the restoration. The survival and success rates of restorations were assessed using the clinical United States Public Health Service (USPHS) criteria at 1 week, and 3, 6, 12, and 18 months' recall times after cementation, and statistical analysis was performed. Results: There was no statistically significant difference between groups and subgroups in terms of all evaluation parameters during the whole observational period. Conclusion: Based on observations, occlusal veneer and endocrown designs fabricated from CAD/CAM VS and VE showed similar clinical success in the rehabilitation of first permanent molars with severe MIH over 18 months of evaluation.

Why orthodontists need to know about molar incisor hypomineralization

Molar incisor hypomineralization (MIH) is a systemic developmental qualitative defect of the enamel that affects 1-4 first permanent molars with or without incisor involvement. Enamel hypomineralization is identified visually as a demarcated opacity with a clear border with varying extensions and can be white, yellow, or brown. This opacity is characterized by a reduced quality of enamel that is of normal thickness but not fully mineralized. It is very common for the affected teeth to present with posteruptive breakdown, making them susceptible to caries, leading to their subsequent loss. Thus, MIH is a significant dental problem with clinical, economic, and psychosocial implications. The planned extraction of compromised teeth is a valid alternative to complex restorative treatment. Orthodontists' involvement is essential in developing effective treatment strategies for children affected by MIH, contributing to their oral health and well-being.

Molar incisor hypomineralization and oral health-related quality of life in Brazilian children: A narrative review of current evidence

The aim of this narrative review was to explore the association between Molar Incisor Hypomineralisation (MIH) and Oral Health-Related Quality-of-Life (OHRQoL) in Brazilian children aged 8-10 years. The study was developed considering the PRISMA guidelines (2020). Five databases were consulted to identify potential studies that used clinical parameters for the detection of MIH; and (b) studies that described aspects of the experience and severity of MIH; (c) records that adopted instruments recommended in the literature to explore OHRQoL in children, according to their respective age groups. The risk of bias of the included studies was analyzed using the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies. Of the 155 initially found, three were included. Of these, two were cross-sectional and one was a case-control study. The diagnosis of MIH was made according to the criteria of the European Academy of Paediatric Dentistry, and OHRQoL was identified using the Child Perceptions Questionnaire (CPQ8-10). The qualitative synthesis of the findings shows that no statistically significant association was identified between MIH and OHRQoL. Only the "oral symptoms domain" of the CPQ8-10 was associated with MIH. The studies were classified as having a low risk of bias (mean: 6.6★/7★). Thus, this study concluded that no significant association was identified between MIH and OHRQoL in Brazilian children. However, MIH may have a negative effect on the perception of oral symptoms in this population group.

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

BackgroundMolar-incisor hypomineralisation (MIH) is the most common developmental abnormality observed in teeth. Being a relatively new condition, its treatment can present a challenge for the dentist. There is currently no study available that has evaluated the knowledge of Mexican dental personnel. This study aimed to evaluate the knowledge, experience, and perceptions of dental surgeons regarding the detection, assessment, and treatment of MIH in the metropolitan area of Mexico City.MethodsA cross-sectional study was designed. Dentists from Mexico City and its metropolitan area were invited through social networks to answer a questionnaire of 30 questions related to MIH. Participants were classified into general practice dentists, paediatric dentists, and other speciality dentists. Pearson’s chi-square test was used for data analysis.ResultsThe questionnaire was answered by 391 dentists. A total of 86% (338 out of 391) of them identified MIH lesions, while 84% of them reported having observed MIH lesions in their practice. The most frequently observed lesions were yellow-brown opacities which accounted for 47% of the lesions, 46% were white opacities, while only 7% were observed as post-eruptive fractures in the enamel as part of the manifestations of MIH. The most frequently reported problem in the management of teeth with MIH was insufficient training for treating children with MIH. A total of 84% of dentists stated that they would like more information on the treatment of MIH lesions.ConclusionsMost of the surveyed dentists recognised MIH and reported having observed MIH lesions in their practice. Most of the dentists indicated that the main problem for the management of the MIH is the lack of training.

The prevalence and characteristics of molar-incisor hypomineralisation in Natal, Brazil

ObjectivesTo determine the prevalence and presentation patterns of molar-incisor hypomineralisation (MIH) in Brazilian children. MethodsA cross-sectional study was carried out with 715 individuals aged 8–17 years. MIH was diagnosed according to European Academy of Paediatric Dentistry (EAPD) criteria, using intraoral photographs. Data were analysed using Chi Square and Pearson's Correlation tests at α = 0.05. ResultsThe prevalence of MIH was 15.66 %. Mild defects represented by demarcated yellow and brown opacities comprised 83.5 % of the total MIH lesions and the severity of MIH lesions increased significantly as age increased. The average number of first molars affected by MIH per child was 2.26, and 36 children (32.14 %) had at least one affected incisor. With the increase of affected molars, the number of incisors with opacities showed an obvious increasing. The maxillary left first molar was the most affected tooth, and the maxillary central incisors were the anterior teeth most frequently affected by MIH. ConclusionThe prevalence of MIH was within the range of published studies and the severity of the defects was mostly mild.

Molar and incisor hypomineralization: Challenge from diagnosis to therapeutic possibilities

The objective of the present study is to discuss, through a narrative literature review, the characteristics of MIH in order to demystify the diagnosis, treatment and prognosis of the affected dental elements. This is a narrative review of qualitative literature. To develop the study, searches were carried out for articles in the main health sciences journals, such as: PubMed, LILACS and Embase. The search filters were applied to studies published between 2019 and 2023. The inclusion criteria involved bibliographic reviews, cohort, cross-sectional, case-control studies, applied research and pilot studies. At the same time, exclusion criteria were established for books, book chapters, letters to the author, abstracts of annals, theses, dissertations, opinion articles and those studies that did not corroborate the proposed objective established for this research. The selected studies totaled 29 articles and were subdivided in order to develop a brief bibliographic review, thus the foundation allowed the development of subtopics: definition, etiology, diagnosis and treatment. It is concluded that molar-incisor hypomineralization (MIH) is a complex dental condition that affects permanent molars and incisors, presenting challenges in diagnosis, treatment and prognosis. Its etiology is multifactorial, and includes genetic, environmental and perinatal factors, resulting in variations in prevalence in different populations. Diagnosis requires a detailed examination due to its similarity to other dental conditions, while treatment ranges from preventative measures to invasive restorations, tailored to the patient's needs.

Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review.

Molar incisor hypomeralisation (MIH) is a dental condition clinically characterised by the presence of morphological and qualitative enamel defects involving the occlusal and/or incisal third of one or more permanent molars or incisors. Its worldwide prevalence ranges between 2.4 and 40%. Several harmful conditions, such as genetic or medical problems during pregnancy, may act together and increase the risk of MIH. The main objective of this systematic review is to assess whether there is a correlation between MIH and dental caries in mixed or permanent dentition. An electronic search was performed on PubMed (Medline), Scopus and Cochrane Library for articles published from August 2022 to April 2023. Cohort, cross-sectional, retrospective and prospective studies were included. In vitro and animal studies, as well as clinical cases and systematic reviews, were excluded. Studies not differentiating between mixed and permanent dentition were excluded. The observed variables were DMFT (Decayed Missed Filled Teeth) score, DMFS (Decayed Missed Filled Surface) and DMF scores related to FPM (First Permanent Molar) and the clinical prevalence of MIH. DMFT, DMFS and DMFT on FPM scores are significantly different between the group of patients with MIH and the control group. The available evidence supports a correlation between MIH lesions and caries. Caries indexes scores increase proportionally to the severity of MIH.

Diet during Pregnancy and Early Life and Molar Incisor Hypomineralization: A Systematic Review

Introduction: Molar Incisor Hypomineralisation (MIH) is a clinical, highly prevalent worldwide condition described in the early 2000s. Evidence about its aetiology is still missing, and preventive strategies can’t be established. The aim of this study was to systematically review the literature on possible correlations between maternal and infant nutrition during the first thousand days of life and the occurrence of MIH.
 Methods: Literature searches of free text and MeSH terms were performed using MedLine (PubMed), Scopus and Google Scholar (from 2017 to February 1st, 2023).
 Results: The search strategy identified 1815 potential articles: 99 from PubMed, 6 from Scopus, and 1710 from Google Scholar. After removing duplicates, papers not meeting the inclusion criteria or being irrelevant, 6 papers were included. They were published between 2019-2022 and were clinical trials or longitudinal studies conducted in Egypt, New Zealand, Turkey, Denmark, Germany and Norway. The sample size was 2005 subjects (mean: 334). All reporting data on MIH was diagnosed according to the European Academy of Paediatric Dentistry criteria. The nutritional exposure variables were: i) malnutrition; ii) vitamin D serum levels in the mother and the child at different stages; iii) celiac disease; iv) the type of infant feeding, such as exclusive breastfeeding and/or type of weaning; v) supplementation with high-dose vitamin D during pregnancy.
 Conclusion: High-dose vitamin D supplementation during pregnancy may be protective against MIH in children. There is a need for structured epidemiological studies specifically designed to investigate the aetiology of MIH in mother-child cohorts.

Evaluation of antimicrobial photodynamic therapy and minimal intervention associated with deproteinisation in permanent teeth with molar incisor hypomineralisation: study protocol for a clinical, controlled, blinded trial

IntroductionMolar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim...