European Archives of Paediatric Dentistry

, Volume 14, Issue 6, pp 375–380 | Cite as

Putative factors associated with molar incisor hypomineralisation: an epidemiological study

  • H. SönmezEmail author
  • G. Yıldırım
  • T. Bezgin
Original Scientific Article



The aim of the study was to examine the aetiological factors involved in the development of molar incisor hypomineralisation (MIH).


The study population comprised 4,049 children (2,029 girls, 2020 boys) aged 7–12 years. Children were examined for MIH in the school environment. Putative aetiological factors were evaluated using a questionnaire sent to children’s families. The questionnaire included questions on prenatal, perinatal, and postnatal systemic conditions. Multivariate analysis was performed using multiple logistic regression, and Pearson’s Chi-square test was used to evaluate nominal or ordinal variables with Fisher’s exact test used in cases of small sample sizes. A level of p < 0.05 was considered statistically significant.


MIH was observed in 7.7 % of the study population. A total of 3,827 completed questionnaires were returned, yielding a response rate of 95.3 %. MIH was found to be associated with prematurity (7 %), gastrointestinal problems (3.9 %), pneumonia (6.3 %), frequent fever (26.1 %), measles (14.7 %), and chickenpox (29.3 %) before age 4 years.


Prevalence did not vary significantly between girls and boys (p > 0.05). Prematurity, gastrointestinal problems, pneumonia, frequent high fever, measles, and chickenpox before age 4 years were found to be significantly related with MIH (p < 0.05).


The aetiology of MIH is not clear yet, and the results of this study support the results of previous studies regarding the putative causal effect of several factors.


Molar incisor hypomineralisation Aetiology Epidemiology 



The authors thank Mr. Ahmet Gül for performing the statistical analysis.


  1. Aine L, Backstrom MC, Maki R et al. Enamel defects in primary and permanent teeth of children born prematurely. J Oral Pathol Med. 2000;29:403–9.PubMedCrossRefGoogle Scholar
  2. Alaluusua S, Lukinmaa PL, Koskimies M et al. Developmental dental defects associated with long breast feeding. Eur J Oral Sci. 1996;104:493–7.PubMedCrossRefGoogle Scholar
  3. Alaluusua S. Aetiology of molar-incisor hypomineralisation: a systematic review. Eur Arch Paediatr Dent. 2010;11:53–8.PubMedCrossRefGoogle Scholar
  4. Balmer RC, Laskey D, Mahoney E, Toumba KJ. Prevalence of enamel defects and MIH in non-fluoridated and fluoridated communities. Eur J Paediatr Dent. 2005;6:209–12.PubMedGoogle Scholar
  5. Beentjez VE, Weerheijm KL, Groen HJ. Factors involved in the etiology of molar-incisor hypomineralization (MIH). Eur J Paediatr Dent. 2002;3:9–13.Google Scholar
  6. Chawla N, Messer LB, Silva M. Clinical studies on molar-incisor-hypomineralisation part 1: distribution and putative associations. Eur Arch Paediatr Dent. 2008;9:180–90.PubMedCrossRefGoogle Scholar
  7. Cho SY, Ki Y, Chu V. Molar incisor hypomineralization in Hong Kong Chinese children. Int J Paediatr Dent. 2008;18:348–52.PubMedCrossRefGoogle Scholar
  8. Commission on Oral Health, Research and 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
  9. Crombie F, Manton D, Kilpatrick N. Aetiology of molar incisor hypomineralization: a critical review. Int J Paediatr Dent. 2009;19:73–83.PubMedCrossRefGoogle Scholar
  10. Ekanayake L, van der Hoek W. Prevalence and distribution of enamel defects and dental caries in a region with different concentrations of fluoride in drinking water in Sri Lanka. Int Dent J. 2003;53:243–8.PubMedCrossRefGoogle Scholar
  11. Freden H, Gronvik M. Prenatal urinary infection and materialization of permanent teeth. Tandlakartidninpen. 1980;72:1382–3.Google Scholar
  12. Ghanim AM, Morgan MV, Marino RJ, Bailey DL, Manton DJ. Molar-incisor hypomineralisation: prevalence and defect characteristics in Iraqi children. Int J Paediatr Dent. 2011;21:413–21.PubMedCrossRefGoogle Scholar
  13. Ghanim AM, Morgan MV, Marino RJ, Bailey DL, Manton DJ. Risk factors of hypomineralized second primary molars in a group of Iraqi schoolchildren. Eur Arch Paediatr Dent. 2012;13:111–8.PubMedCrossRefGoogle Scholar
  14. Heijs SC, Dietz W, Noren JG, Blanksma NG, Jalevik B. Morphology and chemical composition of dentin in permanent first molars with the diagnose MIH. Swed Dent J. 2007;31:155–64.PubMedGoogle Scholar
  15. Jalevik B, Noren JG. Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors. Int J Paediatr Dent. 2000;10:278–89.PubMedCrossRefGoogle Scholar
  16. Jalevik B, Noren GJ, Klingberg G, Barregard L. Etiologic factors influencing the prevalence of demarcated opacities in permanent first molars in a group of Swedish children. Eur J Oral Sci. 2001;109:230–4.PubMedCrossRefGoogle Scholar
  17. Jalevik B, Klingberg GA. Dental treatment, dental fear and behavior management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12:24–32.PubMedGoogle Scholar
  18. Jasulaityte L, Veerkamp JS, Weerheijm KL. Molar incisor hypomineralization: review and prevalence data from the study of primary schoolchildren in Kaunas/Lithuania. Eur Arch Paediatr Dent. 2007;8:87–94.PubMedCrossRefGoogle Scholar
  19. Kotsanos N, Kaklamanos EG, Arapostathis K. Treatment management of first permanent molars in children with molar-incisor hypomineralization. Eur J Paediatr Dent. 2005;12:179–84.Google Scholar
  20. Kuscu OO, Caglar E, Sandalli N. The prevalence and aetiology of molar-incisor hypomineralisation in a group of children in Istanbul. Eur J Paediatr Dent. 2008;9:139–44.Google Scholar
  21. Laisi S, Ess A, Sahlberg C et al. Amoxicillin may cause molar incisor hypomineralization. J Dent Res. 2009;88:132–6.PubMedCrossRefGoogle Scholar
  22. Lygidakis NA, Dimou G, Marinou D. Molar-incisor hypomineralization (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors. Eur Arch Paediatr Dent. 2008;9:207–17.PubMedCrossRefGoogle Scholar
  23. Midodzi WK, Rowe BH, Majaesic CM, Saunders LD, Senthilselvan A. Early life factors associated with incidence of physician-diagnosed asthma in preschool children: results from the Canadian Early Childhood Development Cohort study. J Asthma. 2010;47:7–13.PubMedCrossRefGoogle Scholar
  24. Nikiforuk G, Fraser D. The etiology of enamel hypoplasia: a unifying concept. J Paediatr. 1981;98:888–93.CrossRefGoogle Scholar
  25. Seow WK. A study of the development of the permanent dentition in very low birth weight children. Pediatr Dent. 1996;18:379–84.PubMedGoogle Scholar
  26. Smith CE. Cellular and chemical events during enamel maturation. Crit Rev Oral Biol Med. 1998;9:128–61.PubMedCrossRefGoogle Scholar
  27. Soviero V, Haubek D, Trindade C, Da Matta T, Poulsen S. Prevalence and distribution of demarcated opacities and their sequelae in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children. Acta Odontol Scand. 2009;67:170–5.PubMedCrossRefGoogle Scholar
  28. Souza JF, Costa-Silva CM, Jeremias F et al. Molar incisor hypomineralisation: possible aetiological factors in children from urban and rural areas. Eur Arch Paediatr Dent. 2012;13:164–70.PubMedCrossRefGoogle Scholar
  29. Suga S. Enamel hypomineralization viewed from the pattern of progressive mineralization of human and monkey developing enamel. Adv Dent Res. 1989;3:188–98.PubMedGoogle Scholar
  30. Tapias-Ledesma MA, Jimenez R, Lamas F et al. Factors associated with first molar dental enamel defects: a multivariate epidemiological approach. J Dent Child 2003; 70: 215–220.Google Scholar
  31. Tung K, Fujita H, Yamashita Y, Takagi Y. Effect of turpentine induced fever during the enamel formation of rat incisor. Arch Oral Biol. 2006;51:464–70.PubMedCrossRefGoogle Scholar
  32. van Amerongen WE, Kreulen CM. Cheese molars: a pilot study of the etiology of hypocalcifications in first permanent molars. J Dent Child. 1995;62:266–9.Google Scholar
  33. Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35:390–1.PubMedCrossRefGoogle Scholar
  34. Weerheijm KL. Molar incisor hypomineralisation (MIH). Eur J Paediatr Dent. 2003;4:114–20.PubMedGoogle Scholar
  35. Weerheijm KL, Duggal M, Mejare I et al. Judgment 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;4:110–3.PubMedGoogle Scholar
  36. Whatling R, Fearne JM. Molar incisor hypomineralization: a study of aetiological factors in a group of UK children. Int J Paediatr Dent. 2008;18:155–62.PubMedCrossRefGoogle Scholar
  37. Yamaguti PM, Arana-Chavez VE, Acevedo AC. Changes in amelogenesis in the rat incisor following short-term hypocalcaemia. Arch Oral Biol. 2005;50:185–8.PubMedCrossRefGoogle Scholar
  38. Zawaideh FI, Al-Jundi SH, Al-Jaljoli MH. Molar incisor hypomineralisation in Jordanian children and clinical characteristics. Eur Arch Paediatr Dent. 2011;12:31–6.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  1. 1.Department of Paediatric Dentistry, Faculty of DentistryAnkara UniversityAnkaraTurkey
  2. 2.Pedodonti Anabilim Dalı BesevlerAnkara Üniversitesi Diş Hekimliği FakültesiAnkaraTurkey

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