The effects of maternal pre-pregnancy BMI, pregnancy smoking and alcohol consumption on molar-incisor hypomineralisation: A negative control study

Objectives: (1) To explore the associations between modifiable maternal pregnancy exposures: pre-pregnancy body mass index (BMI), pregnancy smoking and alcohol consumption with offspring molar-incisor hypomineralisation (MIH). (2) To explore for the presence of residual confounding using negative control analyses. Methods: This study used data from Avon Longitudinal Study of Parents and Children (ALSPAC), a UK prospective birth cohort. We defined offspring MIH using prospectively collected questionnaire data. We used logistic regression to explore confounder adjusted associations between maternal pre-pregnancy BMI and smoking and alcohol consumption during pregnancy with MIH. We included negative control exposure (paternal BMI, smoking and alcohol around the time of pregnancy) and outcome (offspring dental trauma) analyses to explore for the presence of residual confounding. Results: 5536 mother/offspring pairs were included (297 MIH cases [5.4%]). We found a positive association between maternal mean BMI and offspring MIH (OR per 1‐kg/m2 difference in maternal BMI: 1.04, 95% CI: 1.00, 1.08). In subsequent analyses, we found evidence that this effect was non-linear and being driven by women in the highest BMI quintiles. In negative control analyses, we found no evidence of association between paternal BMI and offspring MIH (OR: 0.94, 95% CI: 0.89, 1.00) and maternal BMI and offspring dental trauma (OR: 0.99, 95% CI: 0.96, 1.02). There was no clear evidence of an association for maternal pregnancy smoking (OR: 0.76, 95%CI: 0.46, 1.22) and alcohol consumption (OR: 0.79, 95% CI: 0.56, 1.21) with offspring MIH with results imprecisely estimated. Conclusion: In summary we found evidence of a possible intrauterine effect of high maternal pre-pregnancy BMI on offspring MIH. We did not find robust evidence for an intrauterine effect of maternal pregnancy smoking or alcohol consumption on offspring MIH. Our findings provide further support for women of reproductive age to maintain a healthy weight. Future studies are warranted to explore possible mechanisms on how the pregnancy environment may relate to offspring MIH.

Knowledge, attitudes, and beliefs regarding molar incisor hypomineralisation amongst Swiss dental students

Background Knowledge obtained at the undergraduate level regarding molar incisor hypomineralisation (MIH) has an impact on future practice of dentists and paediatric dentists. This cross-sectional study aimed to assess final-year dental students’ knowledge, attitudes and beliefs towards MIH in all Swiss universities. Methods A previously utilised survey (in both English and German) was distributed among final-year dental students in all Swiss dental schools (Basel, Bern, Geneva and Zurich). It probed students’ knowledge, attitudes and beliefs regarding the diagnosis, prevalence, aetiology, and management of MIH, and was structured in two parts: knowledge/perception and clinical application. The students’ responses were analysed statistically with descriptive statistics. Results 113 out of 133 final-year Swiss dental students took part in the study (85%). Nearly all students were familiar with MIH (99%), but only 12% of them felt confident when diagnosing MIH clinically. Direct composite fillings (66%), indirect restorations (28%) and preformed stainless-steel crowns (26%) were chosen as most suitable treatment options for MIH-affected teeth. Conclusion Final-year Swiss dental students are well informed about MIH. However, they report low level of confidence when clinically confronted with MIH-affected teeth regarding its diagnosis and treatment. Swiss Universities curricula should be revisited accordingly.

Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists

Objectives: To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus. Design: A prospective cross-sectional study. Setting: Part 1: Eastman Dental Institute and part 2: online questionnaire. Methods: Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians’ opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios. Results: The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21). Conclusion: The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit

Aim The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment. Methods Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26. Results The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1–6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled. Conclusion Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

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

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.

Management of molar-incisor hypomineralisation by general dental practitioners - part two: treatment

Introduction Molar-incisor hypomineralisation (MIH) is a common occurrence in primary and secondary care settings. While severe cases may need specialist care, mild cases should be managed in primary care.Aims To assess how UK-based general dental practitioners (GDPs) plan treatment for children with MIH using two clinical vignettesDesign An electronic vignette survey was designed using clinical photographs and radiographs. Vignette one presented a child with mild MIH who was unhappy about the appearance of his teeth. Vignette two presented an anxious child with severe MIH, caries and sensitivity. Further questions relating to confidence in management of MIH and referral were included. Participants were UK-based GDPs who regularly treat children. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Fifty-eight GDPs completed the survey. Around half of participants addressed the aesthetic concerns of the child in vignette one. The majority of participants demonstrated sound treatment planning in terms of preventive care and management of molars. More GDPs identified increased caries risk in vignette two.Conclusion These findings demonstrate most GDPs in this study were working as effective tier one and two providers when faced with management of children with MIH.