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Background: Molar-incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes., Aim: To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands., Design: The study was conducted as a cross-sectional web survey. The questionnaire used included questions regarding respondent characteristics, awareness, knowledge and management of MIH and was distributed through the Royal Dutch Association for Dentistry (KNMT) to a random sample of 900 dentists. Variables were analysed using descriptive statistics, and differences between distinct groups of dentists were tested using the chi-squared test., Results: Respondents consisted of 76.6% general dental practitioners, 9.1% paediatric dentists and 14.3% differentiated (specialist) dentists, with a 25.6% overall response rate. The majority knew the term MIH and its clinical characteristics, and could distinguish MIH from other enamel defects. Regarding aetiological factors, 76.6% reported a genetic component. In an asymptomatic case, 47.3% reported non-invasive treatments. In a mild symptomatic case, treatments from non-invasive to invasive were reported (p < .05). In a severe symptomatic case, the majority reported invasive treatments. Two-thirds of respondents were interested in further clinical training about MIH., Conclusions: Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH., (© 2024 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

Background: Despite intensive efforts for categorizing demarcated enamel opacities, often related to molar incisor hypomineralization (MIH), there is a lack of descriptive criteria aiming to describe them physically outside the scope of color and size. This is most likely due to the indices focusing on molar, not anterior, teeth., Aim: To map and classify demarcated lesions on permanent anterior teeth using reflected and transilluminated light. The association between classification and related lesion characteristics was also examined., Design: Permanent anterior teeth with demarcated opacities related to MIH were selected. For each tooth, standardized photographs were taken using transmitted and reflected light. Each lesion was mapped and classified according to its color, lesion size, surface integrity, and type. The data were analyzed using the chi-square and Fisher's exact tests. A logistic regression analysis was performed to identify the risk of PEB., Results: There were significant relationships between lesion size, color, and type with surface integrity. Lesion type and size were more important than lesion color for assessing the risk of PEB. There was also a significant relationship between lesion size and lesion color., Conclusions: Lesion size and type are significant clinical parameters for assessing the risk of PEB on enamel opacities related to MIH., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Background: Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a multifaceted syndrome with a variable phenotype. Few studies have described the associated dental characteristics and their relationship with medical co-morbidities; and no Australian data exist., Aim: To determine the clinical manifestations and correlations between oral and medical conditions in children with 22q11.2DS., Design: A retrospective observational study. Children genetically diagnosed with 22q11.2DS at the Royal Children's Hospital Melbourne were selected; their medical and dental characteristics were collated and analysed., Results: The study population (n = 57; mean age 11.5 years, range 2-27 years) experienced a range of medical conditions involving multiple medical systems; of whom 44 (77.2%) had caries experience, 7 (12.3%) developmentally missing teeth, and 31 (54.4%) developmental defects of enamel (DDE). Smaller proportions of primary teeth were affected by DDE in children with congenital heart disease (2.2% vs 9.7%; P = .02), and cardiac surgery (0.2% vs 9%; P = .001). Conversely, children with hypoparathyroidism (n = 2) had significantly higher proportions of primary teeth affected by DDE (27.5% vs 4%; P = .02)., Conclusions: Significant associations existed between medical conditions (congenital heart disease, history of cardiac surgery, and hypoparathyroidism) and primary dentition DDE in children with 22q11.2 DS., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup & Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician., (© 2021 S. Karger AG, Basel.)

Molar-incisor hypomineralization (MIH) is a condition that is defined based on its peculiar clinical presentation. Original reports on the etiology of the condition and possible risk factors were inconclusive, and we refuted the original suggestion that MIH is an idiopathic condition and suggested that MIH has complex inheritance and is due to the interaction of more than one gene and the environment. Our group was the first to suggest MIH has a genetic component that involves genetic variation in genes expressed during dental enamel formation. Later we expanded this work to include genes related to the immune response. In this report, we provide a rationale to explain the variation seen in the clinical presentation of MIH, which can affect just one molar out of the four or just a portion of a particular molar., (© 2019 S. Karger AG, Basel.)

Background: To address challenges presented to clinicians to diagnose and treat molar incisor hypomineralisation (MIH), a new assessment tool was created., Aim: To explore the reproducibility and validity of a new instrument developed to assess MIH., Methods: Inter-rater and test-retest reliabilities were examined using Cronbach's alpha. Thirty-five oral health professionals scored clinical photographs for the presence/absence of MIH and other enamel defects using the new index. Face, content, and construct validities were assessed. A panel of six experienced researchers assessed face validity. Construct validity was determined by examining hypothesised associations with clinical variables reported to change concurrently or as modifiers of the MIH outcome. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also assessed., Results: The index reflected the hypothesised associations regarding the presence, prevalence, and severity of MIH, demonstrating construct validity. Researchers indicated that codes and definitions were clear and suitable for international use. The index showed satisfactory scores of sensitivity/specificity and PPV/NPV. Examiners achieved "Substantial" to "Almost perfect" levels of agreement in clinical presentation and lesion extension., Conclusions: The tested MIH index had reasonably solid properties providing confidence that it is a reliable and valid instrument for use in population-based and clinical screenings for diagnosis of MIH and other enamel defects., (© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: We aimed to systematically review and meta-analyze the global, super-regional, regional and national prevalence of molar-incisor-hypomineralization (MIH) and to determine the numbers of prevalent and incident cases on different spatial scales. The review was registered (PROSPERO CRD42017063842)., Sources: Five electronic databases (Medline, EMBASE, LILACS, Web of Science, Google Scholar) were searched systematically., Study Selection: Observational studies on the prevalence of MIH were included and the prevalence on different spatial scales (global, super-regional, regional, national) synthesized using random-effects meta-analyses. The prevalence was then regressed on a large set of methodological, socioeconomic and environmental variables to estimate the global burden (incident and prevalent cases) of MIH., Data: Of 2239 identified studies, 99 studies on 113,144 participants from 43 countries were included. The meta-analysis yielded a mean (95% CI) prevalence of 13.1% (11.8-14.5%), with significant differences between super-regions, regions and countries. The number of prevalent cases in 2015 was estimated at 878 (791-971) million people, while the number of incident cases in 2016 was 17.5 (15.8-19.4) million. Of these, 27.4% (23.5-31.7%) (in mean, 240 million prevalent and 4.8 million incident cases, respectively) were or will be in need of therapy due to pain, hypersensitivity or posteruptive breakdown. Heavily populated countries contribute significantly to the burden of prevalent cases, while growing countries like India, but also Pakistan or Indonesia rank first with respect to the number of incident cases., Conclusions: MIH is highly prevalent across the globe. Certain (mainly low- and middle income) countries shoulder the majority of this burden. Clinical significance The consistently high prevalence and the large proportion of cases in need of care should be considered by both clinicians in their daily practice and healthcare planners and policy makers., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim: The aim of the present study was to determine the validity of quantitative light-induced fluorescence-digital (QLF-D) in regard to the detection and quantification of developmental demarcated hypomineralized lesions of enamel in vitro when compared to micro-computed tomography (CT) determination of lesion characteristics. A secondary aim was to develop a protocol for 3-D analysis using micro-CT., Methods: Twenty-four hypomineralized defects were classified as cream/white (CW), yellow/brown (YB), and post-eruptive breakdown. Teeth were scanned using micro-CT. Grayscale and chromatic vertical sections were constructed. Mineral density and porosity percentage were calculated. Fluorescence loss and red fluorescence were determined from images. Linear mixed models were computed., Results: Mineral density and porosity mean values by lesion type were statistically different (P<.001). CW lesions had lower fluorescence loss than YB and broken lesions. Red fluorescence was emitted by the majority of the defects, and the means between lesion types were statistically different (P<.001). The mixed model indicated that mineral density was not correlated with fluorescence loss and lesion type., Conclusion: The present findings support QLF-D as a method to detect hypomineralized lesions of different clinical presentation, with red fluorescence putatively related to the severity of the defects. The micro-CT 3-D approach is a reliable method to analyze structural changes in hypomineralized enamel., (© 2017 John Wiley & Sons Australia, Ltd.)

Objectives: Molar incisor hypomineralization (MIH) is a common developmental dental defect of permanent teeth, which can increase the risk of dental caries, infection and hospitalization. The etiology is currently unclear although prenatal or early childhood health factors are suspected. The aim of this systematic review was to assess the strength of evidence linking etiological factors with MIH., Methods: A systematic search was conducted using the Medline and Embase electronic databases for studies investigating environmental etiological factors of MIH. Two reviewers assessed the eligibility of studies. The level of evidence and bias was determined for all eligible studies according to Australian National Health and Medical Research Council guidelines for systematic reviews of etiology and the Newcastle-Ottawa Scale., Results: From a total of 2254 studies identified through electronic and hand searching, 28 were eligible for inclusion. Twenty-five of these investigated MIH and three investigated a related condition in primary teeth, hypomineralized second primary molars (HSPM), and these were analysed separately. A limited number of studies reported significant associations between MIH and pre- and perinatal factors such as maternal illness and medication use in pregnancy, prematurity and birth complications. Early childhood illness was implicated as an etiological factor in MIH in several studies, in particular fever, asthma and pneumonia. The studies investigating HSPM revealed an association with maternal alcohol consumption, infantile fever and ethnicity. However, the validity of these findings is impaired by study design, lack of adjustment for confounders, lack of detail and consistency of exposures investigated and poor reporting., Conclusions: Childhood illness is likely to be associated with MIH. Further prospective studies of the etiology of MIH/HSPM are needed., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Current molar hypomineralisation (MH) indices do not guide clinicians in management of affected dentitions, and treatment is based on individual judgment., Aim: The aims of this study were to describe characteristics of MH and molar incisor hypomineralisation (MIH) and trial the new Molar Hypomineralisation Severity Index (MHSI)., Design: First permanent molars (FPMs) and permanent incisors (PIs) in 283 affected children were examined for hypomineralisation characteristics [defect colour, location, post-eruptive breakdown (PEB); restorations placed/replaced/atypical; sensitivity]. The MHSI scores were compared with treatment received (152 children)., Results: Mean (SD) affected teeth/dentition were as follows: FPMs: 3.2 (1.0) and PIs: 1.6 (1.6). Affected FPMs showed no arch or quadrant predilection; maxillary central PIs were affected particularly. As affected FPMs/dentition increased, MIH diagnoses also increased (P = 0.009). Among FPMs, defects most prevalent were brown (47%) and cuspal (74%); 67% showed PEB. Before study entry, 43% of FPMs had restorations placed/replaced. Among PIs, white defects were common (65%) on smooth surfaces; sensitivity was rare. Affected FPMs received more restorations and extractions than unaffected FPMs (P = 0.0001). As MHSI scores increased, FPM treatments/dentition increased (number, invasiveness). All characteristics were significant in predicting treatment (logistic regression model)., Conclusions: A spectrum from MH to MIH occurred. The MHSI characteristics were predictive of the treatment of affected FPMs and can guide management., (© 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To investigate and clarify physical and chemical properties of enamel affected by molar incisor hypomineralisation (MIH)., Methods: A series of in vitro studies were performed on extracted molars affected by MIH and sound teeth for controls. Tooth sections underwent Vickers microhardness testing before lapping and subsequent transverse microradiographic analysis and examination under polarised light microscopy. Carbonate content was determined by CO2 release from acid digestion. Unprepared and fractured surfaces were examined under scanning electron microscopy., Results: MIH-affected molars demonstrated a severe degree of hypomineralisation with an average mineral content of only 58.8%vol% mineral. Vickers microhardness was significantly reduced in MIH compared with controls (1.8±1.1 v 4.4±1.0 GPa, p<0.05) and polarised light microscopy revealed the bulk of MIH lesions had a porosity of ≤5% but also substantial areas of ≥10% and smaller areas exceeding 25% porosity. A surface layer was frequently observed on both intact and broken-down lesions and cervical regions of MIH teeth were typically spared. Carbonate content of MIH enamel was higher than control samples (6.6±2.1 v 4.4±1.1 wt%, p<0.05). Scanning electron microscopy showed that both the enamel rod and surface ultrastructure were defective. Clinical characteristics did not consistently correlate with all properties., Conclusions: The properties of MIH-affected enamel significantly differ from those of normal enamel and were highly variable, however some common characteristics were observed. Implications for aetiology and clinical management are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Molar incisor hypomineralization (MIH) involves enamel hypomineralization of systemic origin affecting one or more first permanent molars (FPM) and is often associated with other teeth, particularly the incisors. A challenging condition for both the clinician and the patient, MIH affected teeth are often subjected to repeated treatments and frequently the decision to extract one or more FPM is made. At present, there are no clinical reports of available restorative materials that are able to provide consistently adequate restorations on hypomineralized teeth. The concept of resin infiltration, which involves occluding incipient enamel carious lesions with low viscosity resins to arrest or slow the development of caries has the potential to be applied to hypomineralized enamel. Successful penetration of resin infiltrant into MIH affected enamel may aid in improving its micromechanical properties.