Margarita Silva

Clinical Studies on Molar-Incisor-Hypomineralisation Part 1: Distribution and Putative Associations

Aim: This was to describe the distributions of affected first permanent molars (FPMs) in a sample of children with molar-incisor-hypomineralisation (MIH) and molar hypomineralisation (MH), and to examine their perinatal and medical histories for putative associations with molar hypomineralisation. Study Design: A sample of 416 children aged 6–14 years with MIH or MH was identified from a specialist paediatric dental practice in Melbourne, Australia. Methods: A questionnaire regarding perinatal and medical histories was sent to their parents/guardians; 182 (44%) useable questionnaires were returned and the dental records of these children were reviewed. Results: The 182 dentitions were distributed as: MIH: 104; MH: 65; MIH* (permanent incisors unerupted): 13. These dentitions contained 720 FPMs; 429 FPMs were hypomineralised, distributed as: MIH: 282 FPMs; MH: 124 FPMs; MIH*: 23 FPMs. The 282 affected FPMs occurred in dentitions with MIH as: 1 FPM: 27%; 2 FPMs: 15%; 3 FPMs: 17%; 4 FPMs: 40% (mean 2.7 ± 1.3 FPMs/dentition). The 124 affected FPMs occurred in dentitions with MH as: 1 FPM: 49%; 2 FPMs: 28%; 3 FPMs: 6%; 4 FPMs: 17% (mean 1.9 ± 1.1 FPMs/dentition). The distribution of moderate to severe hypomineralisation in FPMs was: MIH: 89%; MH: 73%. Affected FPMs were similarly distributed between gender, quadrants and arches. At least one condition putatively associated with MIH/MH was seen in histories of 166 children (91 %); ear infections, fevers, and perinatal conditions occurred in 53–66% of children. Frequent condition combinations were: ear infections + fevers (40% of children); antibiotics + ear infections (54%); antibiotics + other illnesses (56%). Conclusions: All four FPMs in a given dentition were more likely to be affected and to differing extents in MIH than in MH. Putative associations appear to exist between MIH/ MH and combinations of antibiotic use, ear infections, fevers, perinatal conditions, and other illnesses in the child’s first 3 years. It is proposed that MIH is a more severe form of the hypomineralisation condition than MH, forming an MIH spectrum.

Clinical studies on molar-incisor-hypomineralisation part 2: development of a severity index.

Aim: This was to examine the records of 182 children (aged 6–14 years) with molar-incisor-hypomineralisation (MIH) or molar hypomineralisation (MH) in order to develop and examine a Hypomineralisation Severity Index for first permanent molars (FPMs). Study Design: Records of 429 FPMs in these children were examined and scored for eruption status, extent of hypomineralisation, sensitivity, number of restorative treatments; summed scores were converted to an index for each dentition (possible range: 1.25–7.00). Indices were examined regarding medical conditions occurring singly or in combinations in parentally-recalled children’s histories to age 3 years; mean indices were compared for dentitions with these conditions/combinations. Results: The proportion of FPMs receiving no/preventive treatment was higher in dentitions with MH than with MIH (56% vs. 41%); restorative treatment for FPMs was more frequent in dentitions with MIH than with MH (45% vs. 29%). Dentitions with MIH had higher severity indices than those with MH (MIH: index range: 3.25–5.25: 43%; MIH: index range: 1.25–2.00: 61 %). Mean severity indices clearly had a higher trend in dentitions of children with certain condition combinations than for those without. Ten condition combinations each contained 3 to 5 medical conditions; 11/12 condition combinations included fevers; 9/12 included chicken pox; 9/12 included perinatal conditions, 6/12 included antibiotic use. Conclusions: A preliminary Hypomineralisation Severity Index developed for dentitions with hypomineralised first permanent molars in children has shown that MIH and MH form part of an MIH spectrum, where MIH is a more severe form of the condition than MH. The index has indicated associations between hypomineralisation of these molars and combinations of medical conditions, particularly implicating fevers, chicken pox, perinatal conditions and antibiotic use. Further clinical studies are indicated to validate the proposed index and confirm its prognostic value in treatment planning.

Distribution and severity of molar hypomineralisation: trial of a new severity index

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.

Dental caries in Victorian nursing homes

BACKGROUND The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. METHODS Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. RESULTS Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. CONCLUSIONS Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice

BackgroundDespite clear assessment criteria, studies of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) are marked by inconsistency in outcome measurements. This has detracted from meaningful comparisons between studies and limited interpretation.AimTo provide a comprehensive manual as a companion to assist researchers in planning epidemiological studies of MIH and HSPM, with particular reference to outcome measurement.MethodsThis manual begins with a succinct review of the clinical problems and evidence for management of the conditions. The subsequent sections guide researchers through diagnosis of MIH and HSPM and implementation of both the long and short forms of a recently proposed grading system. MIH and HSPM can often be confused with fluorosis, enamel hypoplasia, amelogenesis imperfecta, and white spot lesions but can be distinguished by a number of unique clinical features. Based on the grading system, a standardised protocol is proposed for clinical examinations. Intra and inter-examiner reliability is of key importance when outcome measurement is subjective and should be reported in all epidemiological studies of MIH. The manual concludes with an exercise forum aimed to train examiners in the use of the grading system, with answers provided.ConclusionThe use of a standardised protocol, diagnostic and grading criteria will greatly enhance the quality of epidemiological studies of MIH.

Endemic Molar Incisor Hypomineralization: a Pandemic Problem That Requires Monitoring by the Entire Health Care Community

Purpose of ReviewThis review brings a major, previously under-recognized dental and general health problem to the attention of the medical and scientific community. The goals are to help clinicians make early diagnoses, thereby improving treatment outcomes, and to stimulate increasing research efforts to understand the etiology and ultimately prevention.Recent FindingsThere are two recent systematic reviews of molar incisor hypomineralization (MIH). One reveals the global burden of the condition; mean global prevalence is 13% with 878 million people affected, with 4.8 million cases per year requiring treatment. The review into etiology found a lack of definitive knowledge, but that it is likely to be multifactorial, with childhood illness including fever possibly implicated.SummaryThe review presents details of MIH sufficient to enable clinicians to recognize it and understand its impact on affected children, its management, and the importance of early intervention. Much further research is needed.