The impact of MIH/HSPM on the carious lesion severity of schoolchildren from Talca, Chile



Decamarcated hypomineralised lesions of enamel include those developmental defects that are related to MIH, HSPM or any other demarcated opacities of systemic origin. The present study’s aims are to determine MIH/HSPM prevalence, caries lesion severity and their association in a sample of 6–12-year-old schoolchildren from Talca, Chile.


The sample (N = 577) was derived from selected primary schools in urban Talca. A full dental examination was performed at the school by one calibrated examiner. Socio-demographic data and caries experience (DMFT/dmft/merged ICDAS II and PUFA/pufa) were measured in primary and permanent dentitions. MIH/HSPM was assessed using a modified EAPD protocol. Binary and multilevel binary regression analyses were calculated.


The prevalence of MIH/HSPM or other demarcated hypomineralised lesions was 24.4%. MIH and HSPM was 15.8% and 5%, respectively. The presence of HSPM predicted MIH (OR 3.7; 95% CI 1.65–8.15) when corrected by demographic factors. Of the children examined, 35% had no teeth with a score greater than ICDASII Code 0 and 26% had one or more severe carious lesions (Code C). Toothwise multilevel binary regression analyses demonstrated that teeth with MIH/HSPM (OR 3.70) from low-SES children (OR 1.93) had higher odds for carious lesions compared with defect-free teeth from high-SES participants.


MIH/HSPM lesions were associated with carious lesion occurrence and increased disease severity. The prevalence of MIH and HSPM was similar to other reports. Increased awareness of MIH/HSPM in schools and primary health settings may help to identify children at risk early.

This is a preview of subscription content, log in to check access.

Fig. 1



Molar incisor hypomineralisation


Hypomineralised second primary molars


Odds ratio


Decayed missing filled teeth


International caries detection and assessment system


Pulp, ulceration, fistula, abscess index


European Academy of Paediatric Dentistry


  1. Basha S, Mohamed RN, Swamy HS. Prevalence and associated factors to developmental defects of enamel in primary and permanent dentition. Oral Health Dent Manag. 2014;13(3):588–94.

    PubMed  Google Scholar 

  2. Chile Crece Contigo Website. 2018. Accessed Dec 2018.

  3. Cho SY, Ki Y, Chu V. Molar incisor hypomineralization in Hong Kong Chinese children. Int J Paediatr Dent. 2008;18(5):348–52.

    Article  Google Scholar 

  4. Corral-Núñez C, Rodríguez H, Cabello R, Bersezio-Miranda C, Cordeiro RCL, Fresno-Rivas MC. Impacto de la hipomineralización incisivo molar en la experiencia de caries en escolares de 6–12 años en Santiago, Chile. Revista Clínica de Periodoncia. Implantología y Rehabilitación Oral. 2016;9(3):277–83.

    Article  Google Scholar 

  5. Daly D, Waldron JM. Molar incisor hypomineralisation: clinical management of the young patient. J Ir Dent Assoc. 2009;55(2):83–6.

    PubMed  Google Scholar 

  6. Davis EE, Deinard AS, Maïga EWH. Doctor, my tooth hurts: the costs of incomplete dental care in the emergency room. J Public Health Dent. 2010;70(3):205–10.

    Article  Google Scholar 

  7. Elfrink MEC, Schuller AA, Weerheijm KL, Veerkamp JSJ. Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds. Caries Res. 2008;42(4):282–5.

    Article  Google Scholar 

  8. Elfrink MEC, Ten Cate JM, Jaddoe VWV, et al. Deciduous molar hypomineralization and molar incisor hypomineralization. J Dent Res. 2012;91(6):551–5.

    Article  Google Scholar 

  9. Federation Dentaire International (FDI). Commission on Oral Health R, Epidemiology. A review of the developmental defects of enamel index (DDE Index). Int Dent J. 1992;42(6):411–26.

    Google Scholar 

  10. Figueiredo MJ, de Amorim RG, Leal SC, Mulder J, Frencken JE. Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil. Caries Res. 2011;45(5):435–42.

    Article  Google Scholar 

  11. Garot E, Denis A, Delbos Y, et al. Are hypomineralised lesions on second primary molars (HSPM) a predictive sign of molar incisor hypomineralisation (MIH)? A systematic review and a meta-analysis. J Dent. 2018;72:8–13.

    Article  Google Scholar 

  12. Ghanim A, Manton D, Marino R, Morgan M, Bailey D. Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children. Int J Paediatr Dent. 2013a;23(1):48–55.

    Article  Google Scholar 

  13. Ghanim A, Marino R, Morgan M, Bailey D, Manton D. An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren. Int J Paediatr Dent. 2013b;23(1):2–12.

    Article  Google Scholar 

  14. Ghanim A, Elfrink M, Weerheijm K, Mariño R, Manton D. A practical method for use in epidemiological studies on enamel hypomineralisation. Eur Arch Paediatr Dent. 2015;16(3):235–46.

    Article  Google Scholar 

  15. Ghanim A, Marino R, Manton DJ. Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index. Int J Paediatr Dent. 2018. (Epub ahead of print).

    Article  PubMed  Google Scholar 

  16. Giacaman RA, Bustos IP, Bravo-Leon V, Marino RJ. Impact of rurality on the oral health status of 6-year-old children from central Chile: the EpiMaule study. Rural Remote Health. 2015;15(2):3135.

    PubMed  Google Scholar 

  17. International Caries Detection and Assessment System (ICDAS II). Criteria manual appendix. Workshop held in Baltimore, Maryland, March 12–14th. 2005. Accessed July 2014.

  18. Jans MA, Diaz MJ, Vergara GC, Zaror SC. Frequency and severity of the molar incisor hypomineralization in patients treated at the dental clinic of the Universidad de La Frontera, Chile. Int J Odontostomatol. 2011;5(2):133–40.

    Article  Google Scholar 

  19. Kühnisch J, Heitmüller D, Thiering E, et al. Proportion and extent of manifestation of molar-incisor-hypomineralizations according to different phenotypes. J Public Health Dent. 2014;74(1):42–9.

    Article  Google Scholar 

  20. Leppäniemi A, Lukinmaa PL, Alaluusua S. Nonfluoride hypomineralizations in the permanent first molars and their impact on the treatment need. Caries Res. 2001;35(1):36–40.

    Article  Google Scholar 

  21. MINSAL. Análisis de la situación de salud bucal en Chile: Subsecretaría de Salud Pública. División Prevención y Control de Enfermedades. 2010. Accessed Dec 2018.

  22. Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA—an index of clinical consequences of untreated dental caries. Commun Dent Oral Epidemiol. 2010;38(1):77–82.

    Article  Google Scholar 

  23. Muratbegovic A, Markovic N, Ganibegovic Selimovic M. Molar incisor hypomineralisation in Bosnia and Herzegovina: aetiology and clinical consequences in medium caries activity population. Eur Arch Paediatr Dent. 2007;8(4):189–94.

    Article  Google Scholar 

  24. Petrou M, Giraki M, Bissar A-R, et al. Prevalence of molar-incisor-hypomineralisation among school children in four German cities. Int J Paediatr Dent. 2014;24(6):434–40.

    Article  Google Scholar 

  25. Santos H, Elacqua G. Segregación socioeconómica escolar en Chile: elección de la escuela por los padres y un análisis contrafactual teórico. Revista CEPAL. 2016;119:133–48.

    Article  Google Scholar 

  26. Sembrando Sonrisas Website. 2018. Accessed Dec 2018.

  27. Seow WK, Ford D, Kazoullis S, Newman B, Holcombe T. Comparison of enamel defects in the primary and permanent dentitions of children from a low-fluoride district in Australia. Pediatr Dent. 2011;33(3):207–12.

    PubMed  Google Scholar 

  28. Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization—a systematic review. Commun Dent Oral Epidemiol. 2016;44(4):342–53.

    Article  Google Scholar 

  29. Soto L, Tapia R, Jara G, Rodriguez G, Urbina T. Diagnóstico Nacional de Salud Bucal del Adolescente de 12 años y Evaluación del Grado de Cumplimiento de los Objetivos Sanitarios de Salud Bucal 2000–2010. Santiago: Ediciones de Universidad Mayor; 2007.

    Google Scholar 

  30. 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(3):170–5.

    Article  Google Scholar 

  31. Superintendencia de Salud Website. 2018. Accessed Dec 2018.

  32. Weerheijm KL, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35(5):390–1.

    Article  Google Scholar 

  33. 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.

    PubMed  PubMed Central  Google Scholar 

  34. WHO. Oral health surveys: basic methods. 5th ed. Geneva: WHO; 2013.

    Google Scholar 

Download references


We thank the parents and children, school principals and staff, University of Talca Dental Clinic, Melbourne Dental School, Oral Health CRC University of Melbourne and Procter & Gamble (Oral-B) for the donation of tooth brushes and paste. We acknowledge Becas Chile Scholarship program from CONICYT for sponsoring KG’s university fees.


This study was funded by Melbourne Dental School, Postgraduate Research Fund. Becas Chile scholarship program from CONICYT funded the student researcher’s University fees.

Author information



Corresponding author

Correspondence to K. Gambetta-Tessini.

Ethics declarations

Conflict of interest

Procter and Gamble donated toothbrush and toothpaste for participants. However, the company had no influence in the interpretation of the present study’s results. Authors declare that they do not have any conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gambetta-Tessini, K., Mariño, R., Ghanim, A. et al. The impact of MIH/HSPM on the carious lesion severity of schoolchildren from Talca, Chile. Eur Arch Paediatr Dent 20, 417–423 (2019).

Download citation


  • Hypomineralisation
  • Carious lesion
  • MIH
  • HSPM