Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document

Abstract

Aim To update the existing European Academy of Paediatric Dentistry (EAPD) 2010 policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH).’ Methods Experts, assigned the EAPD, worked on two different topics: (A) Aetiological factors involved in MIH, and (B) Treatment options for the clinical management of MIH. The group prepared two detailed systematic reviews of the existing literature relevant to the topics and following a consensus process produced the updated EAPD policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH).’ The GRADE system was used to assess the quality of evidence regarding aetiology and treatment which was judged as HIGH, MODERATE, LOW or VERY LOW, while the GRADE criteria were used to indicate the strength of recommendation regarding treatment options as STRONG or WEAK/CONDITIONAL. Results (A) Regarding aetiology, it is confirmed that MIH has a multifactorial aetiology with the duration, strength and timing of occurrence of the aetiological factors being responsible for the variable clinical characteristics of the defect. Perinatal hypoxia, prematurity and other hypoxia related perinatal problems, including caesarean section, appear to increase the risk of having MIH, while certain infant and childhood illnesses are also linked with MIH. In addition, genetic predisposition and the role of epigenetic influences are becoming clearer following twin studies and genome and single-nucleotide polymorphisms analyses in patients and families. Missing genetic information might be the final key to truly understand MIH aetiology. (B) Regarding treatment options, composite restorations, preformed metal crowns and laboratory indirect restorations provide high success rates for the posterior teeth in appropriate cases, while scheduled extractions provide an established alternative option in severe cases. There is great need for further clinical and laboratory studies evaluating new materials and non-invasive/micro-invasive techniques for anterior teeth, especially when aesthetic and oral health related quality of life (OHRQoL) issues are concerned. Conclusions MIH has been studied more extensively in the last decade. Its aetiology follows the multifactorial model, involving systemic medical and genetic factors. Further focused laboratory research and prospective clinical studies are needed to elucidate any additional factors and refine the model. Successful preventive and treatment options have been studied and established. The appropriate choice depends on the severity of the defects and the age of the patient. EAPD encourages the use of all available treatment options, whilst in severe cases, scheduled extractions should be considered.

Prevalence and Possible Etiological Factors of Molar-Incisor Hypomineralization (MIH) in Population of Silesian Children in Poland: A Pilot Retrospective Cohort Study

“…The criteria used for the diagnosis of MIH were in accordance with the criteria introduced during the European Academy of Pediatric Dentistry (EAPD) meeting, which took place in Athens in 2003 [ 21 ], and the protocol of the research with the inclusion/exclusion criteria ( Table 2 ). The different levels of EAPD classification are presented in the Table 3 [ 4 ].…”

“…In the prenatal period, the factors that can potentially affect ameloblasts’ development are viral infections of a pregnant mother and episodes/periods of high fever, hypertension, diabetes, or medication use in pregnant women [ 3 , 4 ]. The perinatal period and its related complications during labor are premature delivery, cesarean section, or low birth weight, which may also be attributed as potential MIH factors.…”

Prevalence of and factors associated with molar-incisor hypomineralisation in schoolchildren in the canton of Basel-Landschaft, Switzerland

“…Associated and predisposing factors are a major focus of research [10][11][12]. The investigation of potential treatment approaches has progressed significantly during the last two decades and current concepts are based on intensive prophylactic protocols as well as sealing or restoring the affected teeth [13][14][15][16].…”

Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7–9 years of age: a longitudinal study

“…The prevalence of both MIH and HSPM found in this study population was reasonably high, when compared to previous studies (Jalevik et al 2001 ; Leppaniemi et al 2001 ; Elfrink et al 2015 ). Potential explanations for this could be first, that we investigated MIH within the recommended period (i.e., most were 8 years of age); second, that we included demarcated opacities down to 1 mm in the HSPM and MIH variables; and third, that we used examiners experienced in paediatric dentistry, and they received extensive training and calibration in recording HSPM and MIH according to recommended guidelines (Weerheijm et al 2003 ; Lygidakis et al 2022 ).…”