Molar incisor hypomineralization: a study of aetiological factors in a group of UK children

Objectives. The objectives were to investigate the aetiology of molar incisor hypomineralization (MIH), and to discuss previously published studies. Subjects and methods. One hundred and nine children attending the Department of Paediatric Dentistry at the Royal London Hospital were included in the study: 57 children with MIH and 52 controls. Their mothers completed a medical history interview. Results. No significant associations were found with MIH and delivery and birth complications, breastfeeding, immunization history, other illnesses and allergies, general anaesthetics, fluoride history, and trauma or abscesses affecting the primary predecessors. A family history of enamel defects was more commonly reported for MIH children, but the association was not statistically significant. However, MIH was significantly more common among those whose mothers had experienced problems during pregnancy (P = 0.025), those who had chickenpox between the ages of 3 and 3.99 (P = 0.047), and those for whom amoxycillin was the only antibiotic they had received (P = 0.028). Conclusions. The aetiology of MIH remains unclear, and this study questions whether it is because of a lone aetiological insult. This study recommends further research looking at the links with chickenpox occurring around the third year of life and amoxycillin.     

Perception of molar-incisor hypomineralisation (MIH) by Iraqi dental academics

International Journal of Paediatric Dentistry 2011; 21: 261–270 Background. The understanding and detection of molar‐incisor hypomineralisation (MIH) is linked to its recognition by clinicians. No study has investigated dental clinicians’ level of perception regarding MIH in the Middle East region including Iraq. Aim. To determine the perception of Iraqi academic clinicians about MIH prevalence, severity and aetiological factors. Design. A questionnaire, based on previous European and Australian/New Zealand studies was administered to the academic dental staff of Mosul University. Results. A response rate of 77.7% was reported. General dental practitioners represented 30.8% of the total respondents, whilst 65.1% were dentists with post‐graduate qualification. The majority of the respondents (81.2%) encountered MIH in their clinical activities and 37.3% of them identified that the prevalence appeared to have increased in recent years. Fewer than half of the respondents observed MIH affected teeth on a monthly basis. The condition was less commonly seen in primary second molars than the first permanent molars. A variation in views was recorded about MIH specific aetiological factor/s. Respondents advocated the need for clinical training regarding MIH‐aetiological and therapeutic fields. Conclusions. Molar‐incisor hypomineralisation is a condition commonly diagnosed by Iraqi dental academics. No apparent consensus existed between the general and specialist dentists regarding the anticipated prevalence, severity and aetiology of this condition.     

The prevalence of molar incisor hypomineralization (MIH) in a group of children in a highly polluted urban region and a windfarm-green energy island

Backround.  Children's developing teeth may be sensitive to environmental pollutants such as polychlorinated dibenzo- p -dioxins (PCDDs) and polychlorinated dibenzofurans. The term molar incisor hypomineralization (MIH) was introduced to describe the clinical appearance of enamel hypomineralization of systemic origin affecting one or more permanent first molars (PFMs) that are associated frequently with affected incisors.
Aim.  The aim of this study was to determine the prevalance of MIH in children from the most industrialized and polluted region and the most green-energy island of Turkey.
Design.  In September 2007, a retrospective study was initiated in two elementary schools: one, a group of children ( N  = 153) who fitted the criteria from Tavsancil, Kocaeli ( N  = 109) and the other from Bozcaada island, Canakkale ( N  = 44). The soil samples were collected from selected regions in order to determine the contamination levels in a heavily industrialized area and a non-industrialized area.
Results.  Prevalance of MIH in children in Bozcaada island was 9.1%, while prevalance of MIH was 9.2% in Tavsancil. The PCDD/F levels in soil samples collected from Bozcaada and Tavsancil were determined as 1,12 and 8,4 I-TEQ ng/kg dry soil, respectively ( P  < 0.001).
Conclusions.  In this preliminary study with a small study population, prevalence of MIH did not seem to be associated with the levels of PCDD/Fs in the environment.     

Is molar incisor hypomineralisation (MIH) a new disease of the 21st century?

IntroductionThe term molar incisor hypomineralisation (MIH) was used by Weerheijm, Jälevik and Alaluusa in 2001 to describe hypomineralisation of systemic origin of 1–4 permanent first molars, frequently associated with affected incisors. MIH had previously been described by various terms such as, mottling of enamel and cheese molars. Assessment of MIH between studies is confounded by different terminology, resulting in difficulty in being able to ascertain when this disorder initially presented. Asking whether MIH is a new disease of the 21st century, or whether it existed previously, may help to establish if aetiological factors are liked to contemporary lifestyle.Materials and methodsCochrane Library, Embase, Medline and Web of Science were the databases used to conduct an extensive literature search. Specific search terms and inclusion/exclusion criteria were used to identify relevant publications. After the screening process, 13 articles were included in this review, 5 investigated archaeological specimens, whilst the remaining 8 were clinical studies, where participants were born before the 21st century.ResultsFour common themes identified on review of the selected publications were: suggested rates of MIH between archaeological studies vastly differ, clinical studies carried out before 2001 suggest similar rates of MIH to present day, despite use of different terminology. Both archaeologic and clinical studies suggest MIH existed before the 21st century and publications using clinical assessment either focus on children or adolescents.ConclusionAnalysis of the selected publications suggests that MIH was present before the 21st century. This is demonstrated in both clinical and archaeological studies.     

Molar incisor hypomineralization in Hong Kong Chinese children

Background.   Most prevalence studies on molar incisor hypomineralization (MIH) were carried out in European countries, and data from the East-Asian populations were lacking.
Aim.   This study aimed to investigate the prevalence of MIH in Hong Kong Chinese children.
Design.   Since 2006, charting of teeth with MIH was included into the routine dental examination in a school dental clinic. The dental records of grade 6 primary school children who attended annual check-up in this clinic in 2006 were subsequently reviewed retrospectively. The records were selected for this study if the charting indicated that the children were affected by MIH.
Results.   A total of 2635 records were reviewed and 73 cases of MIH were identified. The prevalence of MIH in this group of children was 2.8%. Their mean age was 12, and the male-to-female ratio was 1 : 1.2. The mean decayed, missing, or filled permanent teeth value of those affected was 1.5, which was higher than that of the general Hong Kong Chinese children aged 12 years old (0.8). A total of 192 teeth were affected. The most commonly affected teeth were permanent maxillary first molars, followed by mandibular first molars and maxillary central incisors. Dental fillings and fissure sealants were found in 52 (38%) and 65 (47%) permanent first molars with hypomineralization, respectively. Medical histories were unremarkable in 60 children, whereas early childhood diseases were reported in 13 cases.
Conclusions.   The prevalence of MIH in the permanent dentition of Hong Kong Chinese children was 2.8%. Children with MIH showed higher caries experience in the permanent dentition than the general population of similar age.     

Molar Incisor Hypomineralisation: Current Knowledge and Practice

BackgroundMolar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.ObjectivesHere, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.Materials and methodsA review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.ResultsThere is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.ConclusionsDental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.Key words: Molar incisor hypomineralisation, Developmental enamel defect, Children, Diagnosis, Management     

Prevalence and possible aetiological factors of molar incisor hypomineralisation in Saudi children: A cross-sectional study

BackgroundA new charting system for molar incisor hypomineralisation (MIH) was recently published and is based on the European Academy of Paediatric Dentistry (EAPD) criteria. This charting system aims to standardise MIH data collection. Therefore, there is a need for new MIH prevalence studies using the currently recommended charting-form.AimTo investigate the prevalence and possible aetiological factors of MIH in randomly selected Saudi schoolchildren aged 8–12 years in Riyadh.DesignA randomly selected sample of Saudi schoolchildren aged 8–12 years attending elementary schools in Riyadh was examined using the EAPD short-form charting, which was recently recommended for the standardised collection of epidemiological data on MIH. To investigate possible aetiological factors of MIH, we collected demographic, pregnancy, and medical history using a questionnaire.ResultsA total of 1,562 children participated in the study (48.8% girls, 51.2% boys). The prevalence of MIH was 15.2%, without a significant difference in the prevalence between the sexes. Among those with MIH, 79.4% had affected incisors and 55.9% had hypomineralised second primary molars. The most prevalent clinical defect was demarcated opacities, and the maxillary arch was more affected. Permanent incisors were more affected in boys than in girls. Defects of the first permanent molars were more severe in terms of clinical status and lesion extent than defects of the permanent incisors. MIH was significantly more prevalent in children with a history of early childhood ear infections, respiratory distress, and tonsillitis.ConclusionsMIH is common in Saudi schoolchildren living in Riyadh, with no gender predilection. Hypomineralised second primary molars can be used to predict MIH. MIH was significantly associated with childhood illness during the first three years of life, including ear infection, respiratory distress, and tonsillitis.     

A review of 47 cases of unerupted maxillary incisors

Objectives. To study the prevalence of aetiological factors associated with unerupted maxillary incisors and to follow the outcome of treatment in a study of 47 cases.
Design . A retrospective study.
Setting . The Dental Department, St Luke's Hospital, Malta, the School Dental Clinic of Malta and the private practices of two orthodontists in Malta.
Sample and methods . Forty-seven patients with a total of 53 unerupted maxillary incisors were classified according to the aetiological factors causing non-eruption. The relative prevalence of the various aetiologies were ascertained, and the outcome after treatment was recorded to assess the efficacy of the treatment methods being used.
Results . The most common cause of lack of eruption was the presence of supernumerary teeth (47% of patients). The other 53% of cases were distributed more or less equally between the remaining aetiological factors, which were odontomes (9%), dilacerations (9%), tooth germ malposition (12%), crowding (4%), one case of a calcifying odontogenic cyst (2%) and one case of trauma to the preceding deciduous tooth (2%). The aetiology of 15% of cases could not be ascertained. Once supernumerary teeth were removed, maxillary incisors usually erupted successfully with the help of conventional treatment methods such as surgical exposure and orthodontics. A relatively large number of incisors that failed to erupt due to other aetiological factors had to be extracted.
Conclusions . Maxillary incisors that fail to erupt due to the presence of supernumerary teeth have a better prognosis than unerupted incisors with less common aetiologies.     

Risk factors in the occurrence of molar–incisor hypomineralization amongst a group of Iraqi children

International Journal of Paediatric Dentistry 2013; 23: 197–206 Background. Despite the worldwide increasing interest in the prevalence studies of molar–incisor hypomineralization (MIH), there is still insufficient evidence to verify the aetiological factors of this condition. Aims. To investigate risk factors involved in the development of MIH in a group of school‐aged Iraqi children. Design. Seven‐ to nine‐year‐old school children (823 of 1000 eligible, response rate of 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Mothers completed a medical history questionnaire‐based interview performed in the schools by a trained examiner. Results. For children with MIH, 6% reported no relevant medical history; the remaining 94% reported various medical conditions putatively associated with MIH compared with 70% for the non‐affected group. Post‐natal medical conditions (33.3%) were most frequently reported. When data were split into the possible risk effect groups, maternal psychological stress (OR, 3.24), frequent exposure to ultrasonic scans during the last gestational trimester (OR, 2.51) and birth order as a fourth sibling or later (OR, 3.17 and 5.73, respectively) were previously unreported significant risk factors and postulated as contributing to, or causing the defect. Conclusions. Children with MIH had experienced a greater number of medical conditions than their unaffected peers with no single health event identified as a risk factor.     

Histopathological and microbiological findings associated with retrograde peri-implantitis of extra-radicular endodontic origin: a systematic and critical review

The aim of this study was to systematically review the aetiology, in particular histopathological and microbiological factors, of retrograde peri-implantitis of endodontic origin. The review is registered in the PROSPERO database (CRD42017063898). An electronic search for publications was performed in two databases, from their inception up to October 2018. Subsequently a hand search of the reference lists was conducted. Articles in English and other languages using Latin characters were included. Two independent reviewers selected the studies, extracted and synthesized the data, and assessed the quality. The methodology of the included articles was evaluated using the relevant Joanna Briggs Institute tools. Six studies fulfilled the eligibility criteria and were included in the systematic review. Histopathological examination in the component studies reflected that the presentation of retrograde peri-implantitis involves cyst formation or chronic inflammation. Bacteria found in these lesions included Porphyromonas gingivalis, Corynebacterium, Streptococcus, and Klebsiella pneumoniae. Two studies were judged as having a low possibility of bias and four were judged as having a moderate possibility of bias. This review determined that endodontic complications associated with adjacent teeth, residual infection at the extraction site due to previous apical periodontitis, or refractory apical periodontitis might be considered likely aetiological factors, although the evidence is limited.     

A population-based study on the association between type 2 diabetes and periodontal disease in 12,123 middle-aged Taiwanese (KCIS No. 21)

Aim: We investigated the association between type 2 diabetes mellitus (T2DM) and periodontal disease (PD) in the context of the current periodontal aetiology model.
Material and Methods: In total, 14,747 community residents aged 35–44 years were invited to a community-based PD survey between 2003 and 2006 using the community periodontal index. Significant factors modifying the association between T2DM and PD were ascertained. We further assessed the association between T2DM and the risk for PD, within strata of significant effect modifiers, after controlling for other putative factors.
Results: The prevalence rate was 10% higher in subjects with T2DM than in those without. After controlling for significant factors, T2DM was positively associated with the risk for PD (adjusted odds ratio=1.34,95% confidence interval: 1.07–1.74). The results of interaction assessment showed that only the waist was identified as a statistically significant effect modifier for such a positive association.
Conclusions: The association between T2DM and the risk for PD among young adult was demonstrated. This finding, together with other aetiological factors, fit with the current hypothesized model of the aetiology of periodontitis. However, the effect of T2DM modified by waist measurement should be verified in future studies.     

The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis

Objective: To systematically evaluate the evidence for effectiveness of supportive periodontal care (SPC) provided in specialist care and general practice for patients with chronic periodontitis; to construct a model for the cost effectiveness of SPC.
Search Strategy: Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology.
Selection Criteria: SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome.
Results: Three articles addressed the question ( Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994 ): Δs CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and −0.01 mm (3 years) respectively. In generalist care the Δs CAL during SPC were −2.2, −1.8 and −2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra €288 for one tooth year or an extra €1503/1 mm reduction in loss of attachment for SPC delivered in specialist care.
Conclusion: SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.     

Models for individual oral health promotion and their effectiveness: a systematic review

Background:  There is a recognized need to deliver oral health information to people during clinical encounters to enable them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health education have been shown to be largely ineffective and new approaches are required to address personal motivations for preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for individual oral health promotion.
Methods:  Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that met the inclusion criteria.
Results:  Thirty-two studies were identified in the fields of clinical prevention and health education, motivational interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective method for altering health behaviours in a clinical setting.
Conclusions:  There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the MI approach within the oral health field.     

Polarized light and scanning electron microscopic investigation of enamel hypoplasia in primary teeth

Background.  Enamel hypoplasia is a developmental disturbance during enamel formation, defined as a macroscopic defect in the enamel, with a reduction of the enamel thickness with rounded, smooth borders. Information on the microstructural level is still limited, therefore further studies are of importance to better understand the mechanisms behind enamel hypoplasia.
Aim.  To study enamel hypoplasia in primary teeth by means of polarized light microscopy and scanning electron microscopy.
Methods.  Nineteen primary teeth with enamel hypoplasia were examined in a polarized light microscope and in a scanning electron microscope.
Results.  The cervical and incisal borders of the enamel hypoplasia had a rounded appearance, as the prisms in the rounded cervical area of the hypoplasia were bent. The rounded borders had a normal surface structure whereas the base of the defects appeared rough and porous.
Conclusions.  Morphological findings in this study indicate that the aetiological factor has a short duration and affects only certain ameloblasts. The bottom of the enamel hypoplasia is porous and constitutes possible pathways for bacteria into the dentin.     

A review of feeding interventions for infants with cleft palate.

OBJECTIVE: A literature review was conducted to identify feeding interventions recommended for infants with cleft conditions. Selected articles were critically appraised using an evidence-based practice framework to determine the strength of the evidence underpinning each intervention. DESIGN: Electronic databases were searched for reports of cleft palate feeding interventions. The selected articles were coded as being data driven or not; those containing data were then critically appraised using a recognized evidence hierarchy. Finally, each report was ascribed a level of evidence (from I to IV), depending on the quality of data presented. RESULTS: Fifty-five articles published between 1955 and 2002 were reviewed. There are currently no completed systematic reviews relevant to this body of literature (level I evidence). Two well-designed randomized controlled trials (level II evidence) were found. These were considered to provide the strongest evidence for feeding intervention techniques. These articles described a combination of interventions, including early feeding and nutrition education, as well as assisted feeding methods for infants with isolated cleft conditions. Three examples of level III.3 evidence were also found. Fifty (91%) of 55 articles reviewed were non-data-driven reports of expert opinion (level IV). CONCLUSIONS: A paucity of evidence rated as either moderate or strong prevailed, underscoring the need for ongoing scientific evaluation of feeding interventions used with infants who have cleft palate. A number of factors, including the heterogeneity of samples studied, lack of replication of trials, and small sample sizes, affected the type and strength of evidence underpinning specific feeding interventions.     

Non-surgical treatment of peri-implant mucositis and peri-implantitis: a literature review

Objectives: To review the literature on non-surgical treatment of peri-implant mucositis and peri-implantitis.
Material and Methods: A search of PubMed and The Cochrane Library of the Cochrane Collaboration (CENTRAL) as well as a hand search of articles were conducted. Publications and articles accepted for publication up to November 2007 were included.
Results: Out of 437 studies retrieved a total of 24 studies were selected for the review. Thus the available evidence for non-surgical treatment of peri-implant mucositis and peri-implantitis is scarce.
Conclusions: It was observed that mechanical non-surgical therapy could be effective in the treatment of peri-implant mucositis lesions. Furthermore, the adjunctive use of antimicrobial mouth rinses enhanced the outcome of mechanical therapy of such mucositis lesions. In peri-implantitis lesions non-surgical therapy was not found to be effective. Adjunctive chlorhexidine application had only limited effects on clinical and microbiological parameters. However, adjunctive local or systemic antibiotics were shown to reduce bleeding on probing and probing depths. Minor beneficial effects of laser therapy on peri-implantitis have been shown; this approach needs to be further evaluated. There is a need for randomized-controlled studies evaluating treatment models of non-surgical therapy of peri-implant mucositis and peri-implantitis.     

Non-carious cervical lesions and occlusion: a systematic review of clinical studies

Non-carious cervical lesions (NCCLs) are a group of lesions that affect the cervical area of the teeth. Different aetiological factors have been reported, among them tooth brushing force, erosive agents and occlusal forces. The aim of this study was to ascertain, by means of a systematic review, the association between NCCLs and occlusion. A search was performed in the MEDLINE database, retrieving a total of 286 articles. After title and abstract screening, the clinical investigations were read in full to select those that evaluated the occlusal aspects of NCCL aetiology. This systematic review describes the results of three prospective and 25 cross-sectional studies. As there is an extreme heterogeneity in design, diagnostic criteria, forms of analysis and associated factors, a meta-analysis was not possible. The wide variety of classification and diagnostic criteria reflects a high range of reported prevalence. An extensive heterogeneity of independent variables was noted, even in occlusal analysis, which helps to mask any conclusion about the role of occlusion in NCCL aetiology. The literature reveals that studies on this topic are subject to a substantial amount of bias, such as evaluation (use of non-blinded examiners) and confounding bias (no control of others aetiological factors). Up to now, it has been impossible to associate NCCLs with any specific causal agent, and the role of occlusion in the pathogenesis of non-carious cervical lesions seems as yet undetermined. Therefore, additional studies, properly designed to diminish bias, are warranted.     

Everyday- and dental-pain experiences in healthy Swedish 8–19 year olds: an epidemiological study

Background.  Very little is known about children's everyday pains and dental treatment pains. A child's gender, age, and level of dental anxiety are factors that could interplay with the perception of pain and are thus worth studying.
Aim.  The objectives of this study were to investigate the frequency and reported intensity levels of children's everyday- and dental-pain experiences, and to study the reported pains in relation to gender, age, and dental anxiety.
Design.  Three hundred and sixty-eight consecutive patients (8–19 years, mean age 13.5 years) from three different Public Dental Service were recruited. Pain ratings were obtained using McGrath's Children's Pain Inventory list and some additional items. Dental anxiety was estimated by the Dental Anxiety Scale.
Results.  Most frequently experienced everyday pains were headache and tummy/stomach ache. Among dental treatment events, dental injection was reported to be most often ranked as painful, and more frequently by girls. Both dental and everyday pains were rated higher grouping children with high dental anxiety.
Conclusions.  The frequency of pain experiences are the same in Swedish children as in other populations. There is a relation between dental anxiety and the perception of pain.