Is there an association between molar-incisor hypomineralization and carious lesions in seven to ten-year-old Brazilian schoolchildren? A cross-sectional study
DOI:
https://doi.org/10.1590/1678-7757-2024-0538Keywords:
Molar-Incisor hypomineralization, Dental caries, Child, Epidemiology, Enamel development defectsAbstract
Objective To evaluate whether the presence of molar-incisor hypomineralization (MIH) is associated with a greater number of decayed teeth in schoolchildren. Methodology A cross-sectional study was conducted with a random sample of 347 children aged from seven to ten years in the Brazilian city of Diamantina. The International Caries Detection and Assessment System (ICDAS) criteria were used to determine the number of teeth with moderate/extensive caries (ICDAS codes 3-6). MIH was assessed according to the criteria of the European Academy of Paediatric Dentistry (EAPD). Sociodemographic data and data regarding children's habits were obtained via a questionnaire sent to parents/guardians. Descriptive analyses, Mann Whitney and Kruskal Wallis tests, and Poisson regression were performed. Results The prevalence of MIH was 20.5% and that of moderate/extensive caries was 39.2%. The mean number of teeth with moderate/extensive caries was 1.80 (SD±2.67). The mean number of decayed permanent teeth was 0.69 (SD=1.21), and the mean number of decayed primary teeth was 1.11 (SD=1.89). The number of teeth with moderate/extensive caries was associated with the presence of MIH in children (PR=1.45; 95% CI=1.03-2.04; p=0.031). Furthermore, the number of teeth with moderate/extensive caries was associated with lower monthly family income, high frequency of sugar consumption, and visible plaque (p<0.05). Conclusion The presence of MIH is associated with a greater number of decayed teeth in schoolchildren. Clinical relevance This study suggests that children with MIH are at higher risk of developing caries, emphasizing the importance of specific preventive care and early treatments for this condition. This can influence clinical practices, public health policies, and parental education.
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References
- Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, et al. Terminology of dental caries and dental caries management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res. 2020;54(1):7-14. doi: 10.1159/000503309
» https://doi.org/10.1159/000503309
- Kazeminia M, Abdi A, Shohaimi S, Jalali R, Vaisi-Raygani A, Salari N, et al. Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis. Head Face Med. 2020;16(1):22. doi: 10.1186/s13005-020-00237-z
» https://doi.org/10.1186/s13005-020-00237-z
- Kirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk factors for early childhood caries: a systematic review and meta-analysis of case control and cohort studies. Pediatr Dent. 2019;41(2):95-112.
- Americano GC, Jacobsen PE, Soviero VM, Haubek D. A systematic review on the association between molar incisor hypomineralization and dental caries. Int J Paediatr Dent. 2017;27(1):11-21. doi: 10.1111/ipd.12233
» https://doi.org/10.1111/ipd.12233
- Mazur M, Corridore D, Ndokaj A, Ardan R, Vozza I, Babajko S, et al. MIH and dental caries in children: a systematic review and meta-analysis. Healthcare (Basel). 2023;11(12):1795. doi: 10.3390/healthcare11121795
» https://doi.org/10.3390/healthcare11121795
- Villani FA, Aiuto R, Dioguardi M, Paglia L, Caruso S, Gatto R, et al. Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review. Eur J Paediatr Dent. 2023;24(4):312-20. doi: 10.23804/ejpd.2023.1985
» https://doi.org/10.23804/ejpd.2023.1985
- Ben Salem M, Chouchene F, Masmoudi F, Baaziz A, Maatouk F, Ghedira H. Are molar-incisor hypomineralization and hypomineralized second primary molars predictive of dental caries? A systematic review. Eur J Dent. 2023;17(1):7-15. doi: 10.1055/s-0042-1749360
» https://doi.org/10.1055/s-0042-1749360
- Weerheijm KL, Duggal M, Mejàre I, Papagiannoulis L, Koch G, Martens LC, et al. Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent. 2003;4(3):110-3
- Dave M, Taylor G. Global prevalence of molar incisor hypomineralisation. Evid Based Dent. 2018;19(3):78-9. doi: 10.1038/sj.ebd.6401324
» https://doi.org/10.1038/sj.ebd.6401324
- Jälevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12(1):24-32. doi: 10.1046/j.0960-7439.2001.00318.x
» https://doi.org/10.1046/j.0960-7439.2001.00318.x
- Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008
» https://doi.org/10.1016/j.jclinepi.2007.11.008
- Instituto Brasileiro de Geografia e Estatística - IBGE. Censo Brasileiro de 2010 [Brazilian National Census of 2010]. Rio de Janeiro: IBGE; 2012. Portuguese.
- Atlas Brasil. Perfil do município de Diamantina [Municipality profile of Diamantina] [Internet]. Brasília: UNDP, Ipea and FJP; c2025 [cited 2025 Apr 30]. Portuguese. Available from:
- Peres KG, Nascimento GG, Peres MA, Mittinty MN, Demarco FF, Santos IS, et al. Impact of Prolonged breastfeeding on dental caries: a population-based birth cohort study. Pediatrics. 2017;140(1):e20162943. doi: 10.1542/peds.2016-2943
» https://doi.org/10.1542/peds.2016-2943
- Casagrande L, Seminario AT, Correa MB, Werle SB, Maltz M, Demarco FF, et al. Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study. Clin Oral Investig. 2017;21(3):847-55. doi: 10.1007/s00784-016-1832-1
» https://doi.org/10.1007/s00784-016-1832-1
- Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FS. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent. 2022;23(1):3-21. doi: 10.1007/s40368-021-00668-5
» https://doi.org/10.1007/s40368-021-00668-5
- Ekstrand KR, Martignon S, Ricketts DJ, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent. 2007;32(3):225-35. doi: 10.2341/06-63
» https://doi.org/10.2341/06-63
- Ekstrand KR, Gimenez T, Ferreira FR, Mendes FM, Braga MM. The International Caries detection and Assessment System - ICDAS: a systematic review. Caries Res. 2018;52(5):406-19. doi: 10.1159/000486429
» https://doi.org/10.1159/000486429
- International Caries Classification and Management System (ICCMS). Guidelines for practitioners and educators. London: ORCA; 2014 [cited 2025 Apr 30]. Available from: https://www.iccms-web.com
- Fernández MR, Goettems ML, Demarco FF, Corrêa MB. Is obesity associated to dental caries in Brazilian schoolchildren? Braz Oral Res. 2017;31:e83. doi: 10.1590/1807-3107BOR-2017.vol31.0083
» https://doi.org/10.1590/1807-3107BOR-2017.vol31.0083
- Santos PS, Martins-Júnior PA, Paiva SM, Klein D, Torres FM, Giacomin A, et al. Prevalence of self-reported dental pain and associated factors among eight- to ten-year-old Brazilian schoolchildren. PLoS One. 2019;14(4):e0214990. doi: 10.1371/journal.pone.0214990
» https://doi.org/10.1371/journal.pone.0214990
- Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030. doi: 10.1038/nrdp.2017.30
» https://doi.org/10.1038/nrdp.2017.30
- Nora AD, Rodrigues CS, Rocha RO, Soares FZ, Braga MM, Lenzi TL. Is caries associated with negative impact on oral health-related quality of life of pre-school children? A systematic review and meta-analysis. Pediatr Dent. 2018;40(7):403-11.
- Dantas-Neta NB, Figueiredo MS, Lima CC, Bendo CB, Andrade EM, Lima MD, et al. Factors associated with molar-incisor hypomineralisation in schoolchildren aged 8-10 years: a case-control study. Int J Paediatr Dent. 2018;28(6):570-7. doi: 10.1111/ipd.12412
» https://doi.org/10.1111/ipd.12412
- Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent. 2018;28(2):170-9. doi: 10.1111/ipd.12323
» https://doi.org/10.1111/ipd.12323
- Ebel M, Bekes K, Klode C, Hirsch C. The severity and degree of hypomineralisation in teeth and its influence on oral hygiene and caries prevalence in children. Int J Paediatr Dent. 2018;28(6):648-57. doi: 10.1111/ipd.12425
» https://doi.org/10.1111/ipd.12425
- Sanz M, Beighton D, Curtis MA, Cury JA, Dige I, Dommisch H, et al. Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl 18):S5-S11. doi: 10.1111/jcpe.12682
» https://doi.org/10.1111/jcpe.12682
- Jepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, Dörfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44 Suppl 18:S85-S93. doi: 10.1111/jcpe.12687
» https://doi.org/10.1111/jcpe.12687
- Yousaf M, Aslam T, Saeed S, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Individual, family, and socioeconomic contributors to dental caries in children from low- and middle-income countries. Int J Environ Res Public Health. 2022;19(12):7114. doi: 10.3390/ijerph19127114
» https://doi.org/10.3390/ijerph19127114
- Martins MT, Sardenberg F, Abreu MH, Vale MP, Paiva SM, Pordeus LA. Factors associated with dental caries in Brazilian children: a multilevel approach. Community Dent Oral Epidemiol. 2014;42(4):289-99. doi: 10.1111/cdoe.12087
» https://doi.org/10.1111/cdoe.12087
- Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29(3):238-48. doi: 10.1111/ipd.12484
» https://doi.org/10.1111/ipd.12484
- Firmino RT, Martins CC, Faria LD, Martins Paiva S, Granville-Garcia AF, Fraiz FC, et al. Association of oral health literacy with oral health behaviors, perception, knowledge, and dental treatment-related outcomes: a systematic review and meta-analysis. J Public Health Dent. 2018;78(3):231-45. doi: 10.1111/jphd.12266
» https://doi.org/10.1111/jphd.12266
- Moynihan PJ, Kelly SA. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. 2014;93(1):8-18. doi: 10.1177/0022034513508954
» https://doi.org/10.1177/0022034513508954
- Hancock S, Zinn C, Schofield G. The consumption of processed sugar- and starch-containing foods, and dental caries: a systematic review. Eur J Oral Sci. 2020;128(6):467-75. doi: 10.1111/eos.12743
» https://doi.org/10.1111/eos.12743
- Eskeli R, Lösönen M, Ikävalko T, Myllykangas R, Lakka T, Laine-Alava MT. Secular trends affect timing of emergence of permanent teeth. Angle Orthod. 2016;86(1):53-8. doi: 10.2319/121014-894.1
» https://doi.org/10.2319/121014-894.1
- Sulzler KE, Kramer IV, Menoli AP, Lazzarin HC. Cronologia de erupção do primeiro molar permanente em crianças dos municípios de Santa Helena e Três Barras do Paraná, PR/Brasil [Eruption chronology of the first permanent molar in children from the municipalities of Santa Helena and Três Barras do Paraná, PR/Brazil]. Rev Bras Ci Saude. 2018;22(3):189-94. Portuguese. doi: 10.22478/ufpb.2317-6032.2018v22n3.31512
» https://doi.org/10.22478/ufpb.2317-6032.2018v22n3.31512
- Vandana S, Kandaswamy D, Muthu MS, Aswath Narayanan MB. Sequence and chronology of permanent teeth eruption in 5-18-year-old school children of Chennai and the influence of sex, BMI, and socio-economic status. Am J Hum Biol. 2025;37(1):e24211. doi: 10.1002/ajhb.24211
» https://doi.org/10.1002/ajhb.24211
- Vandana S, Muthu MS, Akila G, Anusha M, Kandaswamy D, Aswath Narayanan MB. Global variations in eruption chronology of permanent teeth: a systematic review and meta-analysis. Am J Hum Biol. 2024;36(8):e24060. doi: 10.1002/ajhb.24060
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