Knowledge and Perceptions of Molar Incisor Hypomineralisation among General Dental Practitioners, Paediatric Dentists, and Other Dental Specialists in Indonesia.

Molar incisor hypomineralisation (MIH) is a qualitative, dental enamel hypomineralisation defect affecting one to four first permanent molars, characterised by the present of asymmetries demarcated opacities, and is prevalent worldwide. An early diagnosis of MIH is crucial, to prevent further complications including the development of dental caries, hypersensitivity, pulp inflammation, and pain. Therefore, a thorough understanding of MIH is of clinical importance. This cross-sectional study aimed to evaluate the knowledge and perception of MIH among general dental practitioners (GD), paediatric dentists (PD), and other dental specialists (DS) in Indonesia using a self-administered questionnaire. Chi-square tests and Kruskal−Wallis tests were employed to analyse the data. A total of 266 dental practitioners­112 GD, 84 PD, and 60 DS­were included in this study and completed the online questionnaire. There were significant differences in the overall knowledge scores between GD, PD, and DS (p < 0.001). Specifically, the different between the tested groups were observed in the knowledge of caries pattern related to MIH and the aetiology of MIH. The majority of PD (83.3%) can differentiate the MIH-related caries pattern from the classic caries pattern. Moreover, the confident level in diagnosing and treating MIH teeth were higher in PD compared to GD and DS (p = 0.000). The majority of dental practitioners in all groups agreed on the necessity to obtain continuing education on MIH including the aetiology, diagnosis, and its treatment to improve their knowledge and confidence in MIH clinical management.

Online videos: The hidden curriculum.

INTRODUCTION: Dental undergraduates will access the Internet searching for learning materials to complement their training; however, open access content is not generally recommended by dental schools. This study aimed to evaluate how dental students are using online video content. MATERIALS AND METHODS: Students from eight Universities (Athens, Birmingham, Brescia, Cardiff, Melbourne, Paris, Sao Paulo and Valdivia) representing three continents were invited to complete a survey on their access and learning from online videos. RESULTS: International students behave similarly when studying dental content online. Of 515 respondents, 94.6% use the Internet as a learning tool. It was observed that videos are not frequently recommended during didactic lectures (9.6%). But many students (79.9%) will use YouTube for their learning which includes clinical procedures. Students will check online content before performing procedures for the first time (74.8%), to understand what was explained in class (65.9%) or read in books (59.5%), to relearn clinical techniques (64.7%) and to visualise rare procedures (49.8%). More than half of the students do not fully trust the accuracy or the reliability of online content. This does not prevent students from watching and sharing dental videos with classmates (64.4%). The content watched is not shared with teachers (23.3%) even when it contradicts what was learnt in the school (38.2%). CONCLUSION: This study concludes that students regularly integrate open access digital resources into learning portfolios but are hesitant to inform their teachers about their viewing habits. Students wish to receive critical skills on how to evaluate the material they encounter outside their traditional learning space.

Prevalence and Distribution of Molar Incisor Hypomineralization in children receiving dental care in Caracas Metropolitan Area, Venezuela.

Great variation has been reported in worldwide prevalence of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molar (HSPM). South America has the highest regional prevalence. The aim of this study was to determine the prevalence and distribution of MIH HSPM in 6- to 12-year-old children who received care at two dental healthcare services (public and private) in Caracas Metropolitan Area, Venezuela. A cross-sectional prospective study was conducted on 145 children, of whom 121 were selected in the stratified random sample. A calibrated examiner (Kappa=0.878/0.831) evaluated all patients following the MIH diagnosis criteria established by the European Academy of Paediatric Dentistry and using a valid and reliable instrument. Data were analyzed with a significance level of 5%. Of the 121 children, 46.28% (56) were male and 53.72% (65) female, average age 8.83 ± 1.61. The prevalence of MIH/HSPM was 25.6%/20%. Both enamel defects were more prevalent in females (p-value=0.026/0.005). Severe MIH/HSPM was present in 21.8%/31.2% of cases. Average number of affected teeth was 4.16 ± 2.19/1.68 ± 0.74; and the condition was more frequent in upper molars (67.7%/51.4%). It was concluded that prevalence of MIH in 6- to 12-year-old Venezuelan children who received care in Caracas Metropolitan Area was higher than the previously estimated prevalence for South America, with predominance of mild affectation and more frequently occurring in upper molars.

Una gran variabilidad ha sido reportada en la prevalencia mundial de Hipomineralización Incisivo-Molar (HIM) y de Hipomineralización del segundo molar primario (HSMP). América del Sur presenta la prevalencia regional más alta. El objetivo de este estudio fue determinar la prevalencia y distribución de HIM y HSMP en niños entre 6 y 12 años atendidos en dos servicios de atención odontológica (público y privado) en el Área Metropolitana de Caracas, Venezuela. Se realizó un estudio prospectivo transversal en 145 niños. Se seleccionaron 121 niños en la muestra aleatoria estratificada. Un examinador calibrado (Kappa=0,878/0,831) evaluó a todos los pacientes siguiendo los criterios de diagnóstico de HIM establecidos por la Academia Europea de Odontología Pediátrica y utilizando un instrumento válido y confiable. Los datos se analizaron con un nivel de significancia del 5%. De los 121 niños, el 46,28% (56) eran varones y el 53,72% (65) mujeres con una edad media de 8,83 ± 1,61. La prevalencia de HIM/HSMP fue del 25,6%/20%. Ambos defectos del esmalte fueron más prevalentes en el grupo de niñas (valor de p-valor=0,026/0,005). La forma severa de HIM/HSMP estuvo presente en el 21,8%/31,2% de los casos. El promedio de número de dientes afectados por paciente fue de 4,16 ± 2,19/1,68 ± 0,74, siendo más frecuente en los molares superiores (67,7%/51,4%). Se concluyó que la prevalencia de HIM en niños venezolanos entre 6 y 12 años atendidos en el Área Metropolitana de Caracas fue superior a la prevalencia estimada previamente para Sudamérica, con predominio de afectación leve y más frecuente en molares superiores.

Prevalence and Distribution of Molar Incisor Hypomineralization in children receiving dental care in Caracas Metropolitan Area, Venezuela / Prevalencia y distribución de Hipomineralización Incisivo-Molar en niños atendidos en el Área Metropolitana de Caracas, Venezuela

ABSTRACT Great variation has been reported in worldwide prevalence of Molar Incisor Hypomineralization (MIH) and Hypomineralized Second Primary Molar (HSPM). South America has the highest regional prevalence. The aim of this study was to determine the prevalence and distribution of MIH HSPM in 6- to 12-year-old children who received care at two dental healthcare services (public and private) in Caracas Metropolitan Area, Venezuela. A cross-sectional prospective study was conducted on 145 children, of whom 121 were selected in the stratified random sample. A calibrated examiner (Kappa=0.878/0.831) evaluated all patients following the MIH diagnosis criteria established by the European Academy of Paediatric Dentistry and using a valid and reliable instrument. Data were analyzed with a significance level of 5%. Of the 121 children, 46.28% (56) were male and 53.72% (65) female, average age 8.83 ± 1.61. The prevalence of MIH/HSPM was 25.6%/20%. Both enamel defects were more prevalent in females (p-value=0.026/0.005). Severe MIH/HSPM was present in 21.8%/31.2% of cases. Average number of affected teeth was 4.16 ± 2.19/1.68 ± 0.74; and the condition was more frequent in upper molars (67.7%/51.4%). It was concluded that prevalence of MIH in 6- to 12-year-old Venezuelan children who received care in Caracas Metropolitan Area was higher than the previously estimated prevalence for South America, with predominance of mild affectation and more frequently occurring in upper molars.

RESUMEN Una gran variabilidad ha sido reportada en la prevalencia mundial de Hipomineralización Incisivo-Molar (HIM) y de Hipomineralización del segundo molar primario (HSMP). América del Sur presenta la prevalencia regional más alta. El objetivo de este estudio fue determinar la prevalencia y distribución de HIM y HSMP en niños entre 6 y 12 años atendidos en dos servicios de atención odontológica (público y privado) en el Área Metropolitana de Caracas, Venezuela. Se realizó un estudio prospectivo transversal en 145 niños. Se seleccionaron 121 niños en la muestra aleatoria estratificada. Un examinador calibrado (Kappa=0,878/0,831) evaluó a todos los pacientes siguiendo los criterios de diagnóstico de HIM establecidos por la Academia Europea de Odontología Pediátrica y utilizando un instrumento válido y confiable. Los datos se analizaron con un nivel de significancia del 5%. De los 121 niños, el 46,28% (56) eran varones y el 53,72% (65) mujeres con una edad media de 8,83 ± 1,61. La prevalencia de HIM/HSMP fue del 25,6%/20%. Ambos defectos del esmalte fueron más prevalentes en el grupo de niñas (valor de p-valor=0,026/0,005). La forma severa de HIM/HSMP estuvo presente en el 21,8%/31,2% de los casos. El promedio de número de dientes afectados por paciente fue de 4,16 ± 2,19/1,68 ± 0,74, siendo más frecuente en los molares superiores (67,7%/51,4%). Se concluyó que la prevalencia de HIM en niños venezolanos entre 6 y 12 años atendidos en el Área Metropolitana de Caracas fue superior a la prevalencia estimada previamente para Sudamérica, con predominio de afectación leve y más frecuente en molares superiores.

Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index.

BACKGROUND: To address challenges presented to clinicians to diagnose and treat molar incisor hypomineralisation (MIH), a new assessment tool was created. AIM: To explore the reproducibility and validity of a new instrument developed to assess MIH. METHODS: Inter-rater and test-retest reliabilities were examined using Cronbach's alpha. Thirty-five oral health professionals scored clinical photographs for the presence/absence of MIH and other enamel defects using the new index. Face, content, and construct validities were assessed. A panel of six experienced researchers assessed face validity. Construct validity was determined by examining hypothesised associations with clinical variables reported to change concurrently or as modifiers of the MIH outcome. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also assessed. RESULTS: The index reflected the hypothesised associations regarding the presence, prevalence, and severity of MIH, demonstrating construct validity. Researchers indicated that codes and definitions were clear and suitable for international use. The index showed satisfactory scores of sensitivity/specificity and PPV/NPV. Examiners achieved "Substantial" to "Almost perfect" levels of agreement in clinical presentation and lesion extension. CONCLUSIONS: The tested MIH index had reasonably solid properties providing confidence that it is a reliable and valid instrument for use in population-based and clinical screenings for diagnosis of MIH and other enamel defects.

Dentists' perception, knowledge, and clinical management of molar-incisor-hypomineralisation in Kuwait: a cross-sectional study.

BACKGROUND: Molar-incisor Hypomineralisation (MIH) is considered as a global dental problem. There is little knowledge of general dental practitioners (GDPs) and dental specialists (DSs) about this condition in different parts of the world, particularly in Gulf Cooperation Council (GCC) countries. Hence, this study has been carried out to assess the knowledge of GDPS and DSs in Kuwait about MIH condition, its clinical presentation and management. Findings would help national school oral health program (SOHP) to promote good oral healthcare. METHODS: A structured questionnaire was distributed to 310 attendees of the 18th Kuwait Dental Association Scientific Conference, Kuwait. Data concerning demographic variables, prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. RESULTS: A response rate of 71.3% (221/310) was reported. 94% of respondents noticed MIH in their practice. Yellow/brown demarcation has been observed as a common clinical presentation (> 50%). Almost 10-20% of MIH prevalence has been reported by the participants. Resin composite was the dental material often used in treating MIH teeth (~ 65%), and fewer than half would use it for treating moderately affected molars. Most respondents would use preformed metal crowns for severe MIH (63%). Dental journals were the information source for DSs; whereas, the internet was the information source for GDPs. Child's behaviour was the main reported barrier for treatment of MIH affected children. Many GDPs felt unconfident when diagnosing MIH compared to dental specialists. Respondents supported the need to investigate MIH prevalence and to receive a clinical training. CONCLUSIONS: Molar incisor hypomineralisation is a recognised dental condition by practitioners in Kuwait. Yellow/brown demarcated opacities were the most reported clinical presentation, and the composite resin was the most preferred dental material for restoring MIH teeth. Most GDPs and dental specialists would use preformed metal crowns for severely affected molars. GDPs reported low levels of confidence in MIH diagnosis which necessitates conducting continuing education courses to provide high- quality dental care for children with MIH.

Validation of quantitative light-induced fluorescence-digital in the quantification of demarcated hypomineralized lesions of enamel.

AIM: The aim of the present study was to determine the validity of quantitative light-induced fluorescence-digital (QLF-D) in regard to the detection and quantification of developmental demarcated hypomineralized lesions of enamel in vitro when compared to micro-computed tomography (CT) determination of lesion characteristics. A secondary aim was to develop a protocol for 3-D analysis using micro-CT. METHODS: Twenty-four hypomineralized defects were classified as cream/white (CW), yellow/brown (YB), and post-eruptive breakdown. Teeth were scanned using micro-CT. Grayscale and chromatic vertical sections were constructed. Mineral density and porosity percentage were calculated. Fluorescence loss and red fluorescence were determined from images. Linear mixed models were computed. RESULTS: Mineral density and porosity mean values by lesion type were statistically different (P<.001). CW lesions had lower fluorescence loss than YB and broken lesions. Red fluorescence was emitted by the majority of the defects, and the means between lesion types were statistically different (P<.001). The mixed model indicated that mineral density was not correlated with fluorescence loss and lesion type. CONCLUSION: The present findings support QLF-D as a method to detect hypomineralized lesions of different clinical presentation, with red fluorescence putatively related to the severity of the defects. The micro-CT 3-D approach is a reliable method to analyze structural changes in hypomineralized enamel.

Prevalence of early childhood caries and enamel defects in four and five-year old Qatari preschool children.

BACKGROUND: Dental caries is the most prevalent chronic disease in early childhood in most communities worldwide. Several studies conducted in the Gulf Cooperation Council countries have documented a high prevalence of early childhood caries (ECC). To date, no studies have been conducted in Qatar to examine the prevalence of ECC and enamel developmental defects in preschool children. The present study aimed to determine the prevalence of ECC and enamel defects in preschool children aged four and five years attending kindergartens in Qatar. METHODS: A descriptive cross-sectional study was performed among 250 children randomly selected from 16 public kindergartens. Caries experience was measured using the World Health Organization caries criteria (dmft) for tooth rather than surface; enamel defects were scored by the modified developmental defects of enamel index. Descriptive statistics and Chi-Square test of relatedness were used. RESULTS: A response rate of 63 % was reported. The overall caries prevalence of the study sample was 89.2 %; 15.6 % of the examined children had ECC and 73.6 % had severe ECC. Developmental enamel defects were present in 39 % of children and 27 % had demarcated enamel opacities. CONCLUSION: The high rate of dental caries and enamel defects recorded in this study for this young age group has strongly emphasized the necessity of community-based preventive programs and professional care that should begin during pregnancy and in early childhood.

Oral health-related knowledge, attitudes and self-efficacy of Australian rural older adults.

OBJECTIVE: A cross-sectional study was conducted involving older adults from social clubs within a regional local government area in the state of Victoria, Australia, to identify factors associated with knowledge, and attitudes about oral health, as well as perceived self-efficacy. METHODS: Participants underwent an oral health interview, followed by a comprehensive oral clinical examination. RESULTS: A total of 225 older adults participated in this study. The mean age was 70.7 (range: 55-96) years. The majority was females (62.0%) and had incomplete secondary education or less (56.1%); 34.2% were fully edentulous. The mean oral health knowledge score was 24.7 (SD 3.8). None of the socio-demographic and oral health variables yielded a significant effect on the knowledge score. The attitude score had a mean of 5.0 (SD 1.6). Four variables remained significant in the multivariate analysis [p < 0.0001]. A dentate female, with tertiary education, had better oral health attitudes. Higher oral health knowledge scores were associated with a better attitude. The overall self-efficacy mean value was 83.1% (SD 10.6). Dental visits and oral health knowledge remained significant in the attitudes multivariate analysis [p < 0.01]. CONCLUSION: Findings indicate that there were some misconceptions in oral health among this group of older adults. These are important influences on the success/failure of an oral health programme. Oral health education is needed to increase older adults' oral health knowledge, in particular of oral cancer, and to some extent periodontal disease, and improves attitudes and oral health self-efficacy. Oral health knowledge, attitudes and self-efficacy were minimally explained by socio-demographic and clinical variables.

Teledentistry: a systematic review of the literature.

We conducted a systematic review of teledentistry applications. We searched the MEDLINE/PubMed, Embase and Cochrane Library databases for relevant articles published from 1992 to 2012. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article. A total of 878 studies were identified, of which 59 fulfilled the inclusion criteria of the review. The articles covered several dental specialties, mostly oral surgery, oral medicine and oral pathology. The most common type of teledentistry application was education (n = 21), followed by diagnosis (n = 16), consultation (n = 3) and treatment (n = 2). Teledentistry studies were reported in a total of 15 countries. The largest number of studies were conducted in the US (n = 22) and there were no studies from developing countries. Most of the reports referred to pilot projects and short-term outcomes, and most of the studies were descriptive. The review indicates that although teledentistry is an area of expansion, there are still some barriers to its increased use.

Risk factors in the occurrence of molar-incisor hypomineralization amongst a group of Iraqi children.

BACKGROUND. Despite the worldwide increasing interest in the prevalence studies of molar-incisor hypomineralization (MIH), there is still insufficient evidence to verify the aetiological factors of this condition. AIMS. To investigate risk factors involved in the development of MIH in a group of school-aged Iraqi children. DESIGN. Seven- to nine-year-old school children (823 of 1000 eligible, response rate of 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Mothers completed a medical history questionnaire-based interview performed in the schools by a trained examiner. RESULTS. For children with MIH, 6% reported no relevant medical history; the remaining 94% reported various medical conditions putatively associated with MIH compared with 70% for the non-affected group. Post-natal medical conditions (33.3%) were most frequently reported. When data were split into the possible risk effect groups, maternal psychological stress (OR, 3.24), frequent exposure to ultrasonic scans during the last gestational trimester (OR, 2.51) and birth order as a fourth sibling or later (OR, 3.17 and 5.73, respectively) were previously unreported significant risk factors and postulated as contributing to, or causing the defect. CONCLUSIONS. Children with MIH had experienced a greater number of medical conditions than their unaffected peers with no single health event identified as a risk factor.

An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren.

BACKGROUND: Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment. AIMS: To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation. DESIGN: Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. RESULTS: Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. CONCLUSION: Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.

Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children.

BACKGROUND: Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. AIM: To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. DESIGN: A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. RESULTS: Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. CONCLUSIONS: The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.

Molar-incisor hypomineralisation: prevalence and defect characteristics in Iraqi children.

BACKGROUND. Little prevalence data relating to molar incisor hypomineralisation (MIH) exist for Middle East populations. AIM. To evaluate the prevalence and the clinical features of MIH in school-aged children residing in Mosul City, Iraq. DESIGN. A cluster sample of 823 7- to 9-year-old children had their first permanent molars and incisors (index teeth) evaluated using the European Academy of Paediatric Dentistry (EAPD) criteria for MIH. The examinations were conducted at schools by a calibrated examiner. RESULTS. Of the children examined, 177 (21.5%) had hypomineralisation defects in at least one index tooth, 153 (18.6%) had at least one affected first molar or first molars and incisors and were considered as having MIH. The most commonly affected teeth were maxillary molars. Demarcated creamy white opacities were the most frequent lesion type. Dental restorations and tooth extraction because of MIH were uncommon. Children with three or more affected teeth were 3.7 times more likely to have enamel breakdown when compared with those children having only one or two affected teeth. CONCLUSIONS. Molar incisor hypomineralisation was common amongst Iraqi children. Demarcated opacities were more prevalent than breakdown. The severity of the lesions increased with the number of affected teeth. The more severe the defect, the greater the involved tooth surface area.

Perception of molar-incisor hypomineralisation (MIH) by Iraqi dental academics.

BACKGROUND: The understanding and detection of molar-incisor hypomineralisation (MIH) is linked to its recognition by clinicians. No study has investigated dental clinicians' level of perception regarding MIH in the Middle East region including Iraq. AIM: To determine the perception of Iraqi academic clinicians about MIH prevalence, severity and aetiological factors. DESIGN: A questionnaire, based on previous European and Australian/New Zealand studies was administered to the academic dental staff of Mosul University. RESULTS: A response rate of 77.7% was reported. General dental practitioners represented 30.8% of the total respondents, whilst 65.1% were dentists with post-graduate qualification. The majority of the respondents (81.2%) encountered MIH in their clinical activities and 37.3% of them identified that the prevalence appeared to have increased in recent years. Fewer than half of the respondents observed MIH affected teeth on a monthly basis. The condition was less commonly seen in primary second molars than the first permanent molars. A variation in views was recorded about MIH specific aetiological factor/s. Respondents advocated the need for clinical training regarding MIH-aetiological and therapeutic fields. CONCLUSIONS: Molar-incisor hypomineralisation is a condition commonly diagnosed by Iraqi dental academics. No apparent consensus existed between the general and specialist dentists regarding the anticipated prevalence, severity and aetiology of this condition.