Abstract

To update the existing European Academy of Paediatric Dentistry (EAPD) 2010 policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH).’ Experts, assigned the EAPD, worked on two different topics: (A) Aetiological factors involved in MIH, and (B) Treatment options for the clinical management of MIH. The group prepared two detailed systematic reviews of the existing literature relevant to the topics and following a consensus process produced the updated EAPD policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH).’ The GRADE system was used to assess the quality of evidence regarding aetiology and treatment which was judged as HIGH, MODERATE, LOW or VERY LOW, while the GRADE criteria were used to indicate the strength of recommendation regarding treatment options as STRONG or WEAK/CONDITIONAL. (A) Regarding aetiology, it is confirmed that MIH has a multifactorial aetiology with the duration, strength and timing of occurrence of the aetiological factors being responsible for the variable clinical characteristics of the defect. Perinatal hypoxia, prematurity and other hypoxia related perinatal problems, including caesarean section, appear to increase the risk of having MIH, while certain infant and childhood illnesses are also linked with MIH. In addition, genetic predisposition and the role of epigenetic influences are becoming clearer following twin studies and genome and single-nucleotide polymorphisms analyses in patients and families. Missing genetic information might be the final key to truly understand MIH aetiology. (B) Regarding treatment options, composite restorations, preformed metal crowns and laboratory indirect restorations provide high success rates for the posterior teeth in appropriate cases, while scheduled extractions provide an established alternative option in severe cases. There is great need for further clinical and laboratory studies evaluating new materials and non-invasive/micro-invasive techniques for anterior teeth, especially when aesthetic and oral health related quality of life (OHRQoL) issues are concerned. MIH has been studied more extensively in the last decade. Its aetiology follows the multifactorial model, involving systemic medical and genetic factors. Further focused laboratory research and prospective clinical studies are needed to elucidate any additional factors and refine the model. Successful preventive and treatment options have been studied and established. The appropriate choice depends on the severity of the defects and the age of the patient. EAPD encourages the use of all available treatment options, whilst in severe cases, scheduled extractions should be considered.

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Molar–incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 (<jats:italic>p</jats:italic> &lt; .05). In a severe symptomatic case, the majority reported invasive treatments. Two‐thirds of respondents were interested in further clinical training about MIH.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH.</jats:p></jats:sec>

Abstract

Introduction: With an estimated 878 million cases worldwide in 2015, molar incisor hypomineralization (MIH) is a growing issue. Early detection and management require knowledge and application of good clinical practices. The aim of the study was to evaluate the knowledge, attitudes, and practices of French dentists regarding MIH. Method: A self-administered questionnaire was distributed to different groups of practitioners between 30 January and 27 March 2023, including members of the French dental practice-based research network, members of the social network “French pediatric dentists,” and members of the professional social network LinkedIn (LinkedIn, Sunnyvale, California, United States). The data from 311 questionnaires were analyzed. Results: Around 277 (89%) practitioners were familiar with MIH, 180 (58%) were perfectly aware of the clinical features of MIH, and 193 (62%) reported being able to clinically identify MIH. Nearly 100% (310) of dentists cited “environmental pollutants” as the most frequent etiological factor. Glass ionomer is the most used restorative material. Conclusion: Education regarding MIH must be improved among dentists to correctly detect, treat, or refer patients. It would seem useful to carry out an MIH prevalence study in France.

Abstract

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

Abstract

Molar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists. A cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS). Overall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training. The average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH.

Abstract

To systematically review the treatment modalities for molar-incisor hypomineralisation for children under the age of 18 years. The research question was, ‘What are the treatment options for teeth in children affected by molar incisor hypomineralisation?’ An electronic search of the following electronic databases was completed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and Open Grey identifying studies from 1980 to 2020. The PRISMA guidelines were followed. The studies were screened, data extracted and calibration was completed by two independent reviewers. Of 6220 potential articles, 34 studies were included. Twenty studies investigated management of molars with fissure sealants, glass ionomer cement, polyacid modified resin composite, composite resin, amalgam, preformed metal crowns, laboratory-manufactured crowns and extractions. In four articles management of incisors with microabrasion, resin-infiltration and a combination of approaches was reported. Eight studies looked at strategies to mineralise MIH-affected teeth and/or reduce hypersensitivity. Two studies investigated patient-centred outcomes following treatment. Due to the heterogeneity between the studies, meta-analysis was not performed. The use of resin-based fissure sealants, preformed metal crowns, direct composite resin restorations and laboratory-made restorations can be recommended for MIH-affected molars. There is insufficient evidence to support specific approaches for the management of affected incisors. Products containing CPP-ACP may be beneficial for MIH-affected teeth.