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Molar incisor hypomineralisation in Lebanon: prevalence and clinical characteristics

European Archives of Paediatric Dentistry volume 21, pages 609–616 (2020)Cite this article

Abstract

Background

Molar incisor hypomineralisation (MIH) is a qualitative enamel developmental defect affecting 1–4 first permanent molars and sometimes the permanent incisors. MIH is extremely widespread around the world and presents a considerable clinical problem in paediatric dentistry. Although, little prevalence data exist for Middle East populations including the Lebanese one.

Aim

The objectives of this study were to investigate the prevalence of MIH in 7–9-year-old Lebanese children, with relevance to gender, jaw and side distribution, and to assess the clinical status, extent and severity of MIH lesions of the affected teeth.

Design

Representative sample (n = 659) of 7–9-year-old Lebanese children attending private and public schools distributed throughout Lebanon was examined for MIH. Clinical status, extent and severity of MIH lesions on FPMs and permanent incisors were scored using the short-form grading method (MIH index) of Ghanim et al. (Eur Arch Paediatr Dent 16:235–246, 2015).

Results

An overall MIH prevalence of 26.7% was reported with no significant predilection for girls over boys. 52.8% of the cases present with only molars and. 47.2% with both molars and incisors and did not present any significant difference between upper and lower jaws (P = 0.325). Left-side FPMs were more affected than the right ones (P = 0.0218). Central incisors were significantly more affected than the laterals in both jaws (P < 0.0001). Maxillary central incisors were significantly more affected than their mandibular counterparts (P < 0.0001). Most of the clinical status was demarcated opacities extended on less than the third of the tooth surface. The extent of lesions correlated significantly with the number of affected molars. Most of the affected teeth presented with mild defects and the degree of severity was not correlated with gender but significantly increased with age.

Conclusions

MIH is prevalent in Lebanon. Further studies are required to analyse the possible systemic and environmental etiologies among Lebanese children.

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References

  • Ahmadi R, Ramazani N, Nourinasab R. Molar incisor hypomineralization: a study of prevalence and etiology in a group of Iranian. Iran J Pediatr. 2012;22(2):245–51.

    PubMed  PubMed Central  Google Scholar 

  • Allazzam SM, Alaki SM, El Meligy OA. Molar incisor hypomineralization, prevalence, and etiology. Int J Dent. 2014;2014:234508.

    PubMed  PubMed Central  Google Scholar 

  • Arora M, Austin C. Teeth as a biomarker of past chemical exposure. Curr Opin Pediatr. 2013;25(2):261–7.

    PubMed  Google Scholar 

  • 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(4):209–12.

    PubMed  Google Scholar 

  • Buchgraber B, Kqiku L, Ebeleseder KA. Molar incisor hypomineralization: proportion and severity in primary public school children in Graz, Austria. Clin Oral Investig. 2018;22(2):757–62.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  • ElfrinK ME, Ghanim A, Manton DJ, Weerheijm KL. Standardised studies on molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM): a need. Eur Arch Paediatr Dent. 2015;16(3):247–55.

    PubMed  Google Scholar 

  • Fagrell TG, Salmon P, Melin L, Noren JG. Onset of molar incisor hypomineralization (MIH). Swed Dent J. 2013;37(2):61–70.

    PubMed  Google Scholar 

  • Farah RA, Swain MV, Drummond BK, Cook R, Atieh M. Mineral density of hypomineralised enamel. J Dent. 2010a;38:50–8.

    PubMed  Google Scholar 

  • Farah RA, Monk BC, Swain MV, Drummond BK. Protein content of molar incisor hypomineralisation enamel. J Dent. 2010b;38:591–6.

    PubMed  Google Scholar 

  • Fteita D, Ali A, Alaluusua S. Molar-incisor hypomineralisation (MIH) in a group of school-aged children in Benghazi, Libya. Eur Arch Paediatr Dent. 2006;7:92–5.

    PubMed  Google Scholar 

  • Ghanim A, Morgan M, Mariño R, Bailey D, Manton D. Molar-incisor hypomineraliation: prevalence and defect characteristics in Iraqi children. Int J Paediatr Dent. 2011;21(6):413–21.

    PubMed  Google Scholar 

  • Ghanim A, Bagheri R, Golkari A, Manton D. Molar-incisor hypomineralisation: a prevalence study amongst primary schoolchildren of Shiraz, Iran. Eur Arch Paediatr Dent. 2014;15(2):75–82.

    PubMed  Google Scholar 

  • Ghanim A, Elfrink M, Weerheijm KL, Marino R, Manton D. A practical method for use in epidemiological studies on enamel hypomineralisation. Eur Arch Paediatr Dent. 2015;16:235–46.

    PubMed  PubMed Central  Google Scholar 

  • Ghanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Marino RJ, Weerheijm KL, Manton DJ. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent. 2017;18:225–42.

    PubMed  Google Scholar 

  • Ghanim A, Mariño R, Manton DJ. Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index. Int J Paediatr Dent. 2019;29(1):6–13.

    PubMed  Google Scholar 

  • Harris EF. Mineralization of the mandibular third molar: a study of American Blacks and Whites. Am J Phys Anthropol. 2007;132:98–109.

    PubMed  Google Scholar 

  • Hernandez M, Boj JR, Espasa E. Do we really know the prevalence of MIH? J Clin Pediatr Dent. 2016;40(4):259–63.

    PubMed  Google Scholar 

  • Hussain G, Al-Halabi M, Kowash M, Hassan A. The prevalence and severity of molar incisor hypomineralization and molar hypomineralization in Dubai, UAE. J Dent Child (Chic). 2018;85(3):102–7.

    Google Scholar 

  • Hussein AS, Faisal M, Haron M, Ghanim AM, Abu-Hassan MI. Distribution of molar incisor hypomineralization in Malaysian children attending university dental clinic. J Clin Pediatr Dent. 2015;39(3):219–23.

    PubMed  Google Scholar 

  • Jälevik B. Prevalence and diagnosis of molar-incisor-hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2010;11:59–64.

    PubMed  Google Scholar 

  • Jälevik B, Klingberg G. Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls-a longitudinal study. Int J Paediatr Dent. 2012;22(2):85–91.

    PubMed  Google Scholar 

  • Jasulaityte L, Veerkamp JS, Weerheijm KL. Molar incisor hypomineralization: review and prevalence data from the study of primary school children in Kaunas/Lithuania. Eur Arch Paediatr Dent. 2007;8:87–94.

    PubMed  Google Scholar 

  • Kevrekidou A, Kosma I, Arapostathis K, Kotsanos N. Molar incisor hypomineralization of eight- and 14-year-old children: prevalence, severity, and defect characteristics. Pediatr Dent. 2015;37(5):455–61.

    PubMed  Google Scholar 

  • Koruyucu M, Özel S, Tuna EB. Prevalence and etiology of molar-incisor hypomineralization (MIH) in the city of Istanbul. J Dent Sci. 2018;13(4):318–28.

    PubMed  PubMed Central  Google Scholar 

  • Lygidakis NA, Dimou G, Briseniou E. Molar-incisor-hypomineralisation (MIH). Retrospective clinical study in Greek children. I. Prevalence and defect characteristics. Eur Arch Paediatr Dent. 2008;9(4):200–6.

    PubMed  Google Scholar 

  • Merwin DR, Harris EF. Sibling similarities in the tempo of human tooth mineralization. Arch Oral Biol. 1998;43(3):205–10.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Ng JJ, Eu OC, Nair R, Hong CH. Prevalence of molar incisor hypomineralization (MIH) in Singaporean children. Int J Paediatr Dent. 2015;25(2):73–8.

    PubMed  Google Scholar 

  • Oliver K, Messer LB, Manton DJ, Kan K, Ng F, Olsen C, Sheahan J, Silva M, Chawla N. Distribution and severity of molar hypomineralisation: trial of a new severity index. Int J Paediatr Dent. 2014;24(2):131–51.

    PubMed  Google Scholar 

  • Parikh DR, Ganesh M, Bhaskar V. Prevalence and characteristics of molar incisor hypomineralisation (MIH) in the child population residing in Gandhinagar. Eur Arch Paediatr Dent. 2012;13(1):21–6.

    PubMed  Google Scholar 

  • Pitiphat W, Luangchaichaweng S, Pungchanchaikul P, Angwaravong O, Chansamak N. Factors associated with molar incisor hypomineralization in Thai children. Eur J Oral Sci. 2014;122(4):265–70.

    PubMed  Google Scholar 

  • Portella PD, Menoncin BLV, de Souza JF, de Menezes JVNB, Fraiz FC, Assunção LRDS. Impact of molar incisor hypomineralization on quality of life in children with early mixed dentition: a hierarchical approach. Int J Paediatr Dent. 2019. https://doi.org/10.1111/ipd.12482.

    Article  PubMed  Google Scholar 

  • Preusser SE, Ferring V, Wleklinski C, Wetzel WE. Prevalence and severity of molar incisor hypomineralization in a region of Germany—prevalence and severity of molar incisor hpomineralization in a region of Germany—a brief communication. J Public Health Dent. 2007;67(3):148–50.

    PubMed  Google Scholar 

  • Rai PM, Jain J, Raju AS, Nair RA, Shashidhar K, Dsouza S. Prevalence of molar incisor hypomineralization among school children aged 9 to 12 years in Virajpet, Karnataka, India. Open Access Maced J Med Sci. 2019;7(6):1042–6.

    PubMed  PubMed Central  Google Scholar 

  • Rai A, Singh A, Menon I, Singh J, Rai V, Aswal GS. Molar incisor hypomineralization: prevalence and risk factors among 7-9 years old school children in Muradnagar, Ghaziabad. Open Dent J. 2018;12:714–22.

    PubMed  PubMed Central  Google Scholar 

  • Reid DJ, Dean MC. Variation in modern human enamel formation times. J Hum Evol. 2006;50(329–46):30.

    Google Scholar 

  • Rodd HD, Boissonade FM, Day PF. Pulpal status of hypomineralized permanent molars. Pediatr Dent. 2007;29(6):514–20.

    PubMed  Google Scholar 

  • Sahlstrand P, Lith A, Hakeberg M, Norén JG. Timing of mineralization of homologues permanent teeth—an evaluation of the dental maturation in panoramic radiographs. Swed Dent J. 2013;37(3):111–9.

    PubMed  Google Scholar 

  • Saitoh M, Nakamura Y, Hanasaki M, Saitoh I, Murai Y, Kurashige Y, Fukumoto S, Asaka Y, Yamada M, Sekine M, Hayasaki H, Kimoto S. Prevalence of molar incisor hypomineralization and regional differences throughout Japan. Environ Health Prev Med. 2018;23(1):55.

    PubMed  PubMed Central  Google Scholar 

  • Salameh P, Farah R, Hallit S, Zeidan RK, Chahine MN, Asmar R, Hosseini H. Self-reported history of stroke and long-term living conditions near air pollution sources: results of a national epidemiological study in Lebanon. Environ Monit Assess. 2018;190(3):153.

    PubMed  Google Scholar 

  • Savabieasfahani M, Ali SS, Bacho R, Savabi O, Alsabbak M. Prenatal metal exposure in the Middle East: imprint of war in deciduous teeth of children. Environ Monit Assess. 2016;188(9):505.

    PubMed  PubMed Central  Google Scholar 

  • Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. J Dent. 2018;68:10–8.

    PubMed  Google Scholar 

  • Soviero V, Haubek D, Trindade C, 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.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  • Vänskä M, Diab SY, Perko K, Quota SR, Albarqouni NMA, Myöhänen A, Punamäki RL, Manduca P. Toxic environment of war: maternal prenatal heavy metal load predicts infant emotional development. Infant Behav Dev. 2019;55:1–9.

    PubMed  Google Scholar 

  • Weerheijm KL, Duggal M, Mejàre I, Papagiannoulis L, Koch G, Martens LC, Hallonsten AL. Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens. Eur J Paediatr Dent. 2003;4(3):110–3.

    PubMed  Google Scholar 

  • Wogelius P, Haubek D, Poulsen S. Prevalence and distribution of demarcated opacities in permanent 1st molars and incisors in 6 to 8-year-old Danish children. Acta Odontol Scand. 2008;66:5864.

    Google Scholar 

  • Zawaideh FI, Al-Jundi SH, Al-Jaljoli MH. Molar incisor hypomineralisation: prevalence in Jordanian children and clinical characteristics. Eur Arch Paediatr Dent. 2011;12:31–6.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

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Author information

Affiliations

  1. Department of Pediatric Dentistry and Public Dental Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon

    R. Elzein & R. Bacho

  2. Medical Genetics Unit, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon

    E. Chouery

  3. Laboratory of Cancer Biology and Cellular Immunology, Department of Biological Sciences, Faculty of Sciences, Lebanese University, Beirut, Lebanon

    F. Abdel-Sater

  4. Department of Forensic Odontology, Human Identification and Anthropology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon

    F. Ayoub

Authors
  1. R. Elzein
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  2. E. Chouery
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  3. F. Abdel-Sater
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  4. R. Bacho
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  5. F. Ayoub
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Correspondence to R. Elzein.

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Research involving human participants and/or animals

The present study was approved by both Ethics Committees of the Lebanese University (#76/2017) and Saint-Joseph University of Beirut (#USJ-2017-143).

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All parents or guardians of the participating children were informed about the study before their enrolment and they gave voluntary consent.

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Elzein, R., Chouery, E., Abdel-Sater, F. et al. Molar incisor hypomineralisation in Lebanon: prevalence and clinical characteristics. Eur Arch Paediatr Dent 21, 609–616 (2020). https://doi.org/10.1007/s40368-019-00505-w

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  • DOI: https://doi.org/10.1007/s40368-019-00505-w

Keywords

  • Molar incisor hypomineralisation
  • Lebanon
  • Prevalence
  • Characteristics
  • MIH index