Child-reported outcomes for the aesthetic management of molar incisor hypomineralisation

Background Molar Incisor Hypomineralisation (MIH), with a global prevalence of 12-14%, is one of the most common developmental defects of enamel (DEE) to affect children. The condition is associated with considerable functional and aesthetic problems with visible incisor opacities potentially having a negative impact on children’s social interaction and self-esteem. This prospective clinical study is the first to evaluate the impact of minimally invasive dental treatments, aimed at improving the appearance of enamel opacities associated with MIH, on children’s oral health-related quality of life and overall well-being. Aim This study aimed to explore the relationships between socio-demographics, clinical status and oral health-related quality of life (OHRQoL) in children with MIH who received aesthetic treatment for their incisor opacities. Materials and methods This clinical study involved children, aged 7-16 years, referred to a UK Dental Hospital for management of permanent anterior teeth enamel opacities of reported cosmetic concern. Following ethical approval, participants completed a number of validated questionnaires, primarily the C-OHIP-SF19, Harter’s Self-Perception Profile for Children (SPPC) and the Friends and Family Test, prior to any intervention (T0). Treatment regimens included: microabrasion, resin infiltration (Icon™, DMG), tooth whitening, composite resin restoration or a combination of treatments. The recruitment, treatment and subsequent visits were conducted from June 2017 to October 2018. Children were reviewed after one (T1) and six (T2) months, completing the questionnaires each time. Clinical photos were taken at each time point. Change in children’s OHRQoL and self-concept at T0, T1 and T2 were analysed using the Friedman’s Two Way Analysis of Variance by Rank and Wilcoxon Signed Rank tests. Links between predictors, the socio-emotional wellbeing domain of C-OHIP-SF19 and children’s OHRQoL were assessed using structural equation modelling and were underpinned by a theoretical model of HRQoL proposed by Wilson and Cleary. Results Of 111 children initially invited, 103 consented to participate and 86 were reviewed at 6-months (83% completion rate). They had a mean age of 11-years (range 7-15), 60% were female and the majority (92%) were White British/Northern European. Most children (56%) received a combination of microabrasion and Icon™. Children were very positive about the treatment they had received (100% likely to recommend their care to friends and family). The total and all C-OHIP-SF19 domain scores were significantly increased following treatment, indicating substantial improvement in OHRQoL (p<0.001). In addition, there was a significant change in the SPPC, Physical Appearance subscale scores, reflecting children’s perceptions that they looked better following treatment (p<0.001). Within the Wilson and Cleary model, a higher number of anterior teeth requiring aesthetic treatment was linked to lower socio-emotional wellbeing scores at T2 (ß=-0.179, p<0.01). Greater need for orthodontic treatment at baseline was related to worse OHRQoL at T2 (ß=-0.154,p<0.05). Higher self-concept at baseline was significantly associated with higher OHRQoL and socio-emotional wellbeing at baseline (ß=0.460,p<0.01 and ß=0.254,p<0.05). Self-concept at baseline indirectly predicted socio-emotional wellbeing at six-months follow-up, via socio-emotional wellbeing at baseline (ß=0.197, p<0.01). Conclusions This is the first study to explore and demonstrate the simultaneous effects of clinical status, self-concept, socio-emotional wellbeing and children’s OHRQoL following simple aesthetic treatment for incisor opacities associated with MIH. Whilst minimal interventions for incisor opacities undoubtedly improve children’s OHRQoL, a number of complex psychosocial factors and clinical confounders may influence this overall outcome

Molar incisor hypomineralisation: current knowledge and practice

Background Molar 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. Objectives Here, we provide an up‐to‐date review of the epidemiology, aetiology, diagnosis and clinical management of MIH. Materials and methods A 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. Results There 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. Conclusions Dental 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

Determinants of children’s oral health-related quality of life following aesthetic treatment of enamel opacities

Objectives To identify clinical and psychosocial predictors of oral health-related quality of life (OHRQoL) in children with molar incisor hypomineralisation (MIH) following aesthetic treatment of incisor opacities. Methods Participants were 7- to 16-year-old children referred to a UK Dental Hospital for management of incisor opacities. Prior to treatment (To), participants completed validated questionnaires to assess OHRQoL and overall health status (C−OHIP-SF19), and self-concept (Harter’s Self-Perception Profile for Children [SPPC]). Interventions for MIH included microabrasion, resin infiltration, tooth whitening or composite resin restoration. Children were reviewed after six months (T1) when they re-completed the C−OHIP-SF19 and SPPC questionnaires. The relationships of predictors with improvement of children’s OHRQoL (T1-To) and children’s overall health status at T1 were assessed using linear and ordinal logistic regression respectively, guided by the Wilson and Cleary’s theoretical model. Results Of 103 participants, 86 were reviewed at T1 (83.5 % completion rate). Their mean age was 11-years (range = 7−16) and 60 % were female. Total and domain OHRQoL scores significantly increased (improved OHRQoL) following MIH treatment. There was a significant positive change in SPPC physical appearance subscale score between To and T1. A higher number of anterior teeth requiring aesthetic treatment were associated with poor improvement of socio-emotional wellbeing at T1 (Coef =-0.43). Higher self-concept at To was associated with greater improvement of socio-emotional wellbeing at T1 (ß = 3.44). Greater orthodontic treatment need (i.e. higher IOTN-AC score) at T0 was linked to worse overall oral health at T1 (OR = 0.43). Conclusions Psychosocial factors and dental clinical characteristics were associated with change in children’s OHRQoL following minimal interventions for incisor opacities. Clinical significance MIH is a common condition and clinicians should be aware of the negative impacts some children experience, particularly those with multiple anterior opacities, poor tooth alignment and low self-concept. However, simple, minimally invasive treatments can provide good clinical and psychosocial outcomes and should be offered to children reporting negative effects

Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study

Molar incisor hypomineralisation (MIH) is a common enamel condition, presenting with incisor opacities, which may be of psychosocial concern to children. This clinical study sought to determine whether minimally invasive treatment, aiming to improve incisor aesthetics, would also improve children's oral health-related quality of life (OHRQoL). 111 MIH patients, aged 7⁻16 years, referred to a UK Dental Hospital, were invited to complete the Child Oral Health Impact Profile (C-OHIP-SF19) prior to any intervention (T₀) and again at one-month following the intervention (T₁) for MIH. Treatment regimens included one or more of the following: Microabrasion; resin infiltration; tooth whitening; resin composite restoration. Data were obtained for 93 children with a mean age of 11 years. Mean total C-OHIP-SF19 score at T₀ was 47.00 (SD = 9.29; range = 0⁻76) and this increased significantly at T₁ to 58.24 (SD = 9.42; range = 0⁻76; p < 0.001, paired t-test), indicating a marked improvement in self-reported OHRQoL. There were no statistically significant differences according to gender. This is the first study to show that simple, minimally invasive dental treatment, to reduce the visibility of enamel opacities, in MIH, can have a positive impact on children's wellbeing

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

Background: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. Methods: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7–16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. Conclusion: This large-scale study has the potential to improve understanding about MIH with benefits for patient management

What children say and clinicians hear : accounts relating to incisor hypomineralisation of cosmetic concern

Aim To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists. Methods Participants included 50 children, aged 7–16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL). Results Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3–218 km) to the hospital service, with an average waiting time of 75 days from referral. Conclusion It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them

An international investigation of Molar Incisor Hypomineralisation (iMIH) and Its association with dental anomalies: development of a protocol

Background: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. Methods: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7–16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. Conclusion: This large-scale study has the potential to improve understanding about MIH with benefits for patient management

An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review

Abstract Purpose 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?’ Methods 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. Results 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. Conclusion 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. </jats:sec