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Year : 2020  |  Volume : 69  |  Issue : 3  |  Page : 150-154

Prevalence and pattern of molar incisor hypomineralization in Delhi Region

Department of Paediatric and Preventive Dentistry, Santosh Deemed to be University, Ghaziabad, Delhi NCR, India

Date of Submission30-May-2020
Date of Acceptance31-Aug-2020
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Rashi Singh
Department of Paediatric and Preventive Dentistry, Santosh Deemed to be University, Ghaziabad, Delhi NCR
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JASI.JASI_101_20

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Introduction: Molar incisor hypomineralisation (MIH) is currently the most prevalent of developmental defects of enamel among children. Molar incisal hypomineralisation presents itself as a serious clinical dilemma for pediatric dentists and clinical practitioners. It is a global endemic. However, its prevalence in India remains uncertain to find prevalence and pattern of MIH in Delhi Region. Material and Methods: A total of 649 children aged between 7 and 10 years were randomly selected from various schools in Delhi National Capital Region (NCR). The teeth were examined moist under natural light. The developmental defects of enamel were graded using the modified European Academy of Pediatric Dentistry judgment Criteria given by Ghanim et al. 2015. Results: A total of 97 subjects presented with MIH of 649 subjects examined. MIH presented with a prevalence of 15%. Creamy white opacities were the most common of defects present, followed by yellowish-brown opacities. Discussion and Conclusion: The prevalence of MIH in the Delhi NCR region is 15%.

Keywords: Demarcated opacities, developmental defects of enamel, European Academy of Pediatric Dentistry, hypomineralized second primary molar, molar-incisor hypomineralization

How to cite this article:
Singh R, Srivastava B, Gupta N. Prevalence and pattern of molar incisor hypomineralization in Delhi Region. J Anat Soc India 2020;69:150-4

How to cite this URL:
Singh R, Srivastava B, Gupta N. Prevalence and pattern of molar incisor hypomineralization in Delhi Region. J Anat Soc India [serial online] 2020 [cited 2023 Feb 4];69:150-4. Available from: https://www.jasi.org.in/text.asp?2020/69/3/150/296902

  Introduction Top

Molar incisor hypomineralisation (MIH) is defined as the clinical appearance of morphological enamel defects involving the occlusal and/or incisal third of one or more permanent molars and is frequently associated with similar defects in permanent incisors. MIH is as a result of the hypomineralization of systematic origin. The term MIH was first cited by Weerheijm et al. 2001.[1],[2]

Any insult or injury to ameloblasts during the formative stage of enamel may lead to qualitative or quantitative defects of enamel. The earlier focus of the research was mainly on developmental defects like amelogenesis imperfect or dental fluorosis, but currently, it has been shifted to MIH due to an increase in the number of cases being reported.[3]

MIH is a chronological qualitative defect of enamel affecting first permanent molars and being associated with permanent incisors usually presenting as well-demarcated creamy white or yellowish enamel defects, which may or may not be associated with posteruptive breakdown (PEB).[4]

There has been a wide disparity in the prevalence reports of MIH. In national epidemiological surveys on caries prevalence, children are normally not screened for the presence of MIH, so little is known about its occurrence. Various studies done worldwide have shown the prevalence of MIH, ranging from 2.4% to 40.2% due to the different criteria used.[5]

With the introduction of the terminology of MIH, European Academy of Paediatric Dentistry (EAPD) gave the first index for specific reporting of MIH in 2003. Other Non-European criteria have also reported with wide variations in the prevalence ranging from as high as 40.2% in Brazilian children (Weerheijm et al. 2003) to as low as 2.8% in Hongkong (Cho et al. 2008).[6],[7]

FDI commission on oral health, research, and epidemiology in 1992 classified enamel defects into two distinct categories: hypomineralized enamel or opacities and-enamel hypoplasia. The first judgment criterion for MIH was given by EAPD in 2003 further modified in 2008.[8],[9]

In 2015 Ghanim et al. proposed a charting method for the purpose of using single unified criteria for reporting of MIH cases, which may help preventing the disparity encountered during data compilation due to different coding criteria being used by different researchers, thus provide a better picture of MIH worldwide.[10]

There have not been any reported studies in India with the new unified criteria to determine the prevalence of MIH; therefore, studies are needed for improved understanding of MIH and its presentation in this region.

The aim of the present study was to determine the prevalence and pattern of MIH in the Delhi Region.

  Material and Methods Top

Study design

Sample size

The present study was conducted on a total of 649 children. Children aged 7–12 years were randomly selected from different schools in the Delhi region.

Inclusion criteria

Normal healthy co-operative children aged 7–12 years, with proper consent duly signed by the parents, were randomly selected for the study.

Exclusion criteria

Children having other enamel defects such as amelogenesis imperfecta, dentinogenesis imperfecta, hypoplastic diffused enamel defects, tetracycline stains on index teeth were excluded from the study.

Furthermore, noncooperative children or children affected by any systemic diseases were excluded from the study.

Examination of index teeth

Clinical examination for MIH was conducted in the school itself. Each child was examined by a single examiner under natural light, while seated on a school chair. A trained assistant helped record the findings during intra-oral examination.

The teeth were examined moist. Any debris, if present-were removed with a gauze swab. Four first permanent molar and permanent incisors were examined in each child and evaluated according to base on the modified EAPD charting and recording criteria given by Ghanim et al. 2015.

Children with lesions smaller than 2 mm were excluded from further evaluation [Figure 1] and [Figure 2]. Teeth which were currently erupting or erupted <2/3rd were considered to be unerupted. A child was diagnosed positive for MIH if at least one of the erupted first permanent molars presented with a demarcated defect on enamel >2 mm in diameter [Figure 3] and [Figure 4].
Figure 1: Normal Incisors

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Figure 2: Normal molar

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Figure 3: Molar incisor hypomineralisation lesion in incisors

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Figure 4: Molar incisor hypomineralisation lesion in molar

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The data of patients was recorded on a preprinted pro formas with subject's demographic details.

Data were collected manually, tabulated in MS windows excel sheet and analyzed using SPSS software version 17.0 (Inc., Chicago, USA). Data were assessed using Pearson's Chi-square test, Spearman's co-efficient, Fisher's extract, McNemara's test, etc.

  Results Top

A total of 649 subjects were examined, of which 97 subjects (15%) reported with the presence of MIH. No significant differences were found between males and females in MIH prevalence.

Number of subjects with only molars involved were 40 (6.22%), whereas subjects who showed involvement of both molars and incisors affected were 57 (8.78%).

Of the entire subjects involved total number of molars affected were 244/388 (62.89%).

[Table 1] shows the distribution of MIH in molars. There was no significant predilection towards right or left side. Mandibular molars were more commonly affected than the maxillary molars.
Table 1: Number of molars affected

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Of all the teeth involved, a total of 131/776 incisors were affected (16.88%).

[Table 2] shows the distribution of MIH in incisors. There was no right or left predilection. Maxillary incisors appeared to be more commonly affected than mandibular incisors.
Table 2: Number of incisors affected

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[Table 3] shows the presentation of MIH in molars. Two molars were the most commonly affected followed by the involvement of both maxillary and mandibular molars of both arches simultaneously. Single molar involvement was less common.
Table 3: Number of molar teeth affected as per subjects

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[Table 4] shows the presentation of MIH in Incisors. Single incisor involvement was the most common, and usually, the maxillary incisors were most involved.
Table 4: Number of incisor teeth affected as per subjects

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[Table 5] shows surface involvement in molars. About 48% of the molars surfaces were affected. Buccal and occlusal surfaces were the most commonly affected. Lingual or palatal surface involvement was less.
Table 5: Number of surfaces affected in molars

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  • Total number of surfaces-732
  • Total number of surfaces affected-352 (48.09%).

Coming to defect characteristics in molars, Creamy white opacities were the most usually encountered in about 81.53% of surfaces involved, followed by yellowish-brown opacities in 18.46%. PEB was also seen in 5.97% of surfaces.

  Discussion Top

MIH is a term used to describe hypoplastic developmental defects in enamel. The term was first introduced by Weerhejeim et al. in 2003. It describes a special pattern of enamel defects affecting the permanent first molars and incisors. The defects present as clearly demarcated opacities ranging from white to yellow to yellowish-brown which may be associated with PEB.

MIH is very frequent in populations across the world. The European academy has long recognized MIH as a global phenomenon necessitating further research and knowledge to have full understanding of the defect. Furthermore, the EAPD had announced criteria specifically for MIH evaluation.

However, there was a wide variation in defect prevalence due to the use of different criteria and indices across the globe; cross comparison of data are difficult. Other non-European countries also showed a wide disparity in the prevalence of MIH, ranging from a low of 2.8% in Hong Kong to a high of 40.2% in Brazil.

Considering this, a unified diagnostic criterion was proposed by Ghanim et al. in 2015. This criteria proposed a grading method that allowed separate classification for hypomineralized demarcated lesions of the enamel (MIH) and also differentiated it from other similar defects. It also aids in grading the severity of the lesion.

In this study, permanent molars and incisors were scored based on the same criteria. The study reported a prevalence of MIH was 15%, which was in sync with studies done by Kusku et al. 14.9%, Laisi et al. 16.3%, and Balmer et al. 15.9%.[11],[12] It was moderately prevalent than studies done by Bhaskar et al. 9.46%, Parikh et al. 9.2%.[13],[14] This study showed that MIH in Delhi was moderately prevalent in comparison with data from other cities and countries.

There were differences found between investigations in regard to MIH. This may be because of the reason that the criteria used for investigations were different or self-made at time.[15] In this study a criterion strictly for MIH was applied and not adapted from other criteria. The modified DDE index does not differentiate clearly between hypomineralisation and certain other enamel defects.

With the standardization of criteria, the prevalence of MIH has shown a gradual increase due to proper diagnosis of lesion and more cases being reported; thus has become a significant concern which needs to be taken care of.

The introduction of EAPD criteria for the evaluation and diagnosis of MIH was considered due to its simplicity which allows easy clinical reproducibility for recording defects. The criterion was standardized by Ghanim et al. in 2015, which was used in the present study.

The following study was done in the school campus itself in daylight conditions without using artificial light, which was in accordance with other studies conducted. Given the similarity in age group among different studies, the difference in results may be contributed to differences in criteria used, geographical locations, and other environmental factors.

Of the total subjects affected, about 63% had one or more molars affected. Incisors affected were less commonly affected, about 17% of cases. Although few studies have found a high prevalence of MIH in girls compared to boys, there was no significant gender prevalence in the present study.[16],[17]

Mandibular molars were more commonly affected than maxillary molars. In incisors, there was no significant arch prevalence; it was more or less the same for both arches. The right side appeared to be more commonly effected than the left arch for MIH though the results were not statistically significant.[18]

Coming to lesion characteristics, white spot lesions were the most common in molars, followed by yellowish-brown lesions. PEB was most commonly associated with yellowish-brown lesions. The results showed a positive association between the change in color of enamel from white to yellowish-brown and the severity of the lesion. This remained constant for all ages. Also with an increase in the number of surfaces involved, there was an increase in the severity of the lesion.

In incisors, central incisors were most affected followed by mandibular central incisors then lateral incisors. The defect was almost 100% confined to the buccal surface and more common in the maxillary arch though not statistically significant. Other studies also reported similar findings where the subjects with an increased no of affected teeth reported with an increase in the severity and extent of lesions Jalevik et al. 2001, Leppaneimi et al. 2001, Lygidakis et al. 2008, Ghanim et al. 2011, Parikh et al. 2012.[19],[20],[21]

The incisors affected by MIH exhibited demarcated opacities with enamel loss. This was in line with other studies which stated that incisors rarely exhibit postoperative breakdown due to the absence of masticatory forces upon these surfaces.[22]

In epidemiological studies reporting of the severity of the defect is of greater importance as it reflects upon the treatment needs required by the children affected.

There is a lack of a demarcated classification for MIH lesions, which makes it difficult to diagnose the condition and provide solutions needed.

  Conclusion Top

MIH is the most prevalent current endemic faced by pediatric dentists and clinicians today, which needs to be attended as early as possible.

Further studies are needed in various regions of India to establish the exact current status of MIH in India using the recently standardized modified coding criteria.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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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.  Back to cited text no. 2
Elfrink ME, Schuller AA, Weerheijm KL, Veerkamp JS. Hypomineralized second primary molars: Prevalence data in Dutch 5-year-olds. Caries Res 2008;42:282-5.  Back to cited text no. 3
Jeremias F, de Souza JF, Silva CM, Cordeiro Rde C, Zuanon AC, Santos-Pinto L. Dental caries experience and molar-incisor hypomineralization. Acta Odontol Scand 2013;71:1-7.  Back to cited text no. 4
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Cho SY, Ki Y, Chu V. Molar incisor hypomineralization in Hong Kong Chinese children. Int J Paediatr Dent 2008;18:348-52.  Back to cited text no. 7
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Kusku 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.  Back to cited text no. 11
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;6:79-83.  Back to cited text no. 12
Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best clinical practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy document. Eur Arch Paediatr Dent 2010;11:75-81.  Back to cited text no. 13
Parikh DR, Ganesh M, Bhaskar V. Prevalence and characteristics of Molar Incisor Hypomineralisation (MIH) in the child population residing in Gandhinagar, Gujarat, India. Eur Arch Paediatr Dent 2012;13:21-6.  Back to cited text no. 14
Oliver K, Messer LB, Manton DJ, Kan K, Ng F, Olsen C, et al. Distribution and severity of molar hypomineralisation: Trial of a new severity index. Int J Paediatr Dent 2014;24:131-51.  Back to cited text no. 15
Elfrink ME, Ten Cate JM, Jaddoe VW, Hofman A, Moll HA, Veerkamp JS. Deciduous molar hypomineralization and molar incisor hypomineralization. J Dent Res 2012;91:551-5.  Back to cited text no. 16
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Jälevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent 2002;12:24-32.  Back to cited text no. 19
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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