European Archives of Paediatric Dentistry

, Volume 9, Issue 4, pp 191–199 | Cite as

Clinical Studies on Molar-Incisor-Hypomineralisation Part 2: Development of a Severity Index

  • N. Chawla
  • L. B. MesserEmail author
  • M. Silva


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.

Key words

Molar-Incisor-Hypomineralisation Molar Hypomineralisation Severity Index 


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  1. Beentjes VE, Weerheijm KL, Groen HJ. Factors involved in the aetiology of Molar-Incisor-Hypomineralisation (MIH). Eur J Pediatr Dent 2002;1:9–13.Google Scholar
  2. Brook AH, Smith JM. The aetiology of developmental defects of enamel: A prevalence and family study in East London, UK. Connect Tissue Res 1998;39:151–6.PubMedCrossRefGoogle Scholar
  3. Chawla N, Messer LB, Silva M. Clinical studies in molar hypomineralisation Part I: Distribution and putative associations. Eur Arch Paediatr Dent 2008;9:180–190.PubMedGoogle Scholar
  4. Fagrell TG, Lingström P, Olsson S, Steiniger F, Norén JG. Bacterial invasion of dentinal tubules beneath apparently intact but hypomineralised enamel in molar teeth with molar-incisor-hypomineralisation. Int J Paediatr Dent 2008;18:333–40.PubMedCrossRefGoogle Scholar
  5. Fayle S. Molar-Incisor-Hypomineralisation: restorative management. Eur J Paediatr Dent 2003;4:133–37.Google Scholar
  6. FDI Commission on Oral Health Research & Epidemiology. A review of the developmental defects of enamel index (DDE Index). Report of an FDI Working group. Int Dent J 1992;42:411–26.Google Scholar
  7. Fearne J, Anderson P, Davis GR. 3D X-ray microscopic study of the extent of variations in enamel density in first permanent molars with idiopathic enamel hypomineralisation. Br Dent J 2004;196:634–8.PubMedCrossRefGoogle Scholar
  8. Jälevik B, Dietz W, Norén JG. Scanning electron micrograph analysis of hypomineralised enamel in permanent first molars. Int J Paediatr Dent 2005;15:233–40.PubMedCrossRefGoogle Scholar
  9. Jälevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralisation of their first permanent molars. Int J Paediatr Dent 2002;12:24–32.PubMedGoogle Scholar
  10. Jälevik B, Norén JG. Enamel hypomineralisation of permanent first molars. A morphological study and survey of possible aetiological factors. Int J Paediatr Dent 2000;10:278–89.PubMedCrossRefGoogle Scholar
  11. Jälevik B, Norén J, Klingberg G, Barregård L. Etiologic factors influencing the prevalence of demarcated opacities in permanent first molars in a group of Swedish children. EurJ Oral Sci 2001;109:230–34.CrossRefGoogle Scholar
  12. Lygidakis N, Dimou G, Vidaki E. Molar-incisor-hypomineralisation. A retrospective study of 360 children. Part II. Possible aetiological factors. Eur Arch Paediatr Dent 2008;9:207–217.PubMedGoogle Scholar
  13. Leppäniemi A, Lukinmaa PL, Alaluusua S. Nonfluoride hypomineralisations in the permanent first molars and their impact on the treatment need. Caries Res 2001;35:36–40.PubMedCrossRefGoogle Scholar
  14. Mejàre I, Bergman E, Grindefjord M. Hypomineralised molars and incisors of unknown origin: treatment outcome at age 18 years. Int J Paediatr Dent 2005;15:20–28.PubMedCrossRefGoogle Scholar
  15. Rodd HD, Boissonade FM, Day PF. Pulpal status of hypomineralised permanent molars. Pediatr Dent 2007;29:514–20.PubMedGoogle Scholar
  16. van Amerongen W, Kreulen C. Cheese molars: a pilot study of the etiology of hypocalcifications in first permanent molars. J Dent Child 1995;62:266–69.Google Scholar
  17. Weerheijm KL. Molar-incisor-hypomineralisation (MIH). Eur J Paediatr Dent 2003;4:115–20.Google Scholar
  18. Weerheijm K, Duggal M, Mejàre I 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 Pediatr Dent 2003;4:110–13.Google Scholar
  19. Weerheijm KL, Groen HJ, Beentjes VE, Poorterman JH. Prevalence of cheese molars in eleven-year-old Dutch children. ASDC J Dent Child 2001;68:259–62.PubMedGoogle Scholar
  20. Whatling R, Fearne JM. Molar-incisor-hypomineralisation: A study of aetiological factors in a group of UK children. Int J Paed Dent 2008;18:155–62.CrossRefGoogle Scholar
  21. William V, Burrow MF, Messer LB. Microshear bond strength of resin composite to teeth affected by molar hypomineralisation using two adhesive systems. Pediatr Dent 2006;28:233–41.PubMedGoogle Scholar
  22. Williams JK, Gowans AJ. Hypomineralised first permanent molars and the orthodontist. Eur J Paediatr Dent 2003;4:129–32.PubMedGoogle Scholar

Copyright information

© Adis International 2008

Authors and Affiliations

  1. 1.Paediatric Dentistry, Melbourne Dental SchoolThe University of MelbourneAustralia

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