Genetic polymorphisms associated with developmental defects of enamel: A systematic review.

BACKGROUND: Polymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE). AIM: To evaluate the existing literature on genetic polymorphisms associated with DDE. DESIGN: This systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS: One thousand one hundred and forty-six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety-two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar-incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions. CONCLUSION: MIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.

Analysis of the stomatognathic system functions and mastication muscles in children affected by molar hypomineralization (MH): a cross-sectional study.

PURPOSE: To analyze the functions of the stomatognathic system in children with or without molar-incisor hypomineralization (MIH). METHODS: For this cross-sectional study, 72 children aged 6-12 years were recruited and divided in two groups: with MIH (G1) and without MIH (G2). T-SCAN was used to verify the distribution of occlusal contacts, gnathodynamometer to measure maximum molar bite force, and Iowa Oral Pressure Instrument (IOPI) to assess the strength of facial expression muscles. The t test and paired t test (p ≤ 0.05) were used for statistical comparisons. RESULTS: The molars affected by MIH exhibited lower distribution of occlusal forces (p < 0.001) and lower maximum molar bite force (p < 0.05) compared to the molars in the control group. However, there was no difference between the MIH-affected sides compared to the unaffected side, nor between the molars affected by MIH and their antagonists (p > 0.05). There were no differences in the forces of the facial expression muscles between the groups. CONCLUSIONS: These findings suggest that MIH significantly impacts occlusal force distribution and bite force, but not facial expression musculature.

Which are the clinical consequences of Molar Incisor hypomineralization (MIH) in children and adolescents? Systematic review and meta-analysis.

OBJECTIVE: This systematic review was conducted to address the following research question: "What are the clinical consequences (outcome) of Molar Incisor Hypomineralization (MIH) (exposure) in children and adolescents (population/patient)?". MATERIAL AND METHODS: After defining the strategy, a search was performed in different databases (MEDLINE via Pubmed, Cochrane Library, BBO, LILACS, Scopus, Web of Science, Embase) and Grey literature in August 2023. Cross-sectional observational studies that identified clinical consequences of MIH (dental caries, post-eruptive structural loss, atypical restorations, hypersensitivity and tooth extraction) were included. The risk of bias was assessed following the Joanna Briggs Institute protocol for cross-sectional studies. Meta-analyses were conducted for each outcome, taking into account the number of patients and teeth. The effect measure considered was the prevalence; random-effects model was adopted. Heterogeneity was assessed using I2 statistics and prediction intervals (PI). RESULTS: A total of 903 studies were identified; 41 were selected for qualitative analysis and 38 for quantitative analysis. Twenty eight studies were classified as presenting uncertain risk of bias, 11 as low risk and 3 as high risk of bias. The prevalence levels, ranked from highest to lowest and considering the tooth and patient units, respectively, were: caries lesions (0.252 - 95% CI 0.158-0.375; 0.512 - 95% CI 0.385-0.639); hypersensitivity (0.286 - 95% CI 0.190-0.407; 0.417 - 95% CI 0.197-0.674), post-eruptive fracture (0.125 - 95% CI 0.099-0.158; 0.257 - 95% CI 0.145-0.412); atypical restorations (0.048 - 95% CI 0.030-0.077; 0.167 - 95% CI 0.096 - 0.274); tooth extraction (0.012 - 95% CI 0.007-0.019; 0.090 - 95% CI 0.019 - 0.331). All meta-analyses resulted in heterogeneity greater than 85%, with the exception of the outcome "tooth extraction" according to the tooth unit (I2 = 57.83). This heterogeneity may be attributed to factors such as differences in the location where the study was realized, the socioeconomic conditions of the studied population, the asymmetric nature of MIH, and patient age. CONCLUSION: The most common consequences of MIH are caries lesions, hypersensitivity, and post-eruptive breakdown. (PROSPERO:CRD42020201410).

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries.

OBJECTIVE: Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. METHODS: A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. RESULTS: When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167). CONCLUSION: Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. CLINICAL RELEVANCE: The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Traumatic dental injuries and molar incisor hypomineralization: a cross-sectional study of schoolchildren from southern Brazil.

PURPOSE: To describe the prevalence and the variables associated with TDIs in schoolchildren aged 8 to 14 years in Estância Velha city in southern Brazil, placing emphasis on molar incisor hypomineralization. METHODS: Students enrolled in public schools of a medium-sized city in the southern Brazil were selected using cluster random sampling. Clinical examinations assessed molar incisor hypomineralization-MIH (European Academy of Pediatric Dentistry criteria), dental caries (DMFT index), and TDIs (O'Brien's criteria). Socioeconomic and demographic variables were assessed using a standardized questionnaire. Prevalence ratios were estimated using Poisson regression (p < 0.05). RESULTS: 513 students (54.8% female), with a mean age of 11.6 (± 1.9) years, participated in the study. The prevalence of TDIs was 11.3%, with enamel fracture representing 90.4%. The high prevalence of traumatic dental injuries was associated with MIH (PR: 2.22 CI: 1.27; 3.87; p < 0.01) and overjet > 3 mm (PR: 2.03 CI 1.19; 3.45; p < 0.01). CONCLUSION: The sample of schoolchildren from southern Brazil had a low prevalence of traumatic dental injuries. Molar incisor hypomineralization and increased overjet were associated with the higher prevalence of traumatic dental injuries.

Spatial distribution of molar incisor hypomineralization (mih) opacities in first permanent molars

Aim: To evaluate the spatial distribution of MIH opacities in first permanent molars (FPM). Materials and methods: an analysis of intraoral photographs of FPM with demarcated MIH opacities was conducted. The presence of opacity was computed in a digital matrix, discriminating the anatomical regions of the FPM surfaces. The frequencies of distribution of the opacities were descriptively analyzed through 227 FPM digital images of 89 children built in GIMP and Python and by Spearman correlation (= 0,05). Results: the occlusal surface was the most affected one (94% to 100%). In the upper FPM, the palatine surface was the second most affected one (84%-91%). In the lower FPM, the vestibular surface was the second most affected one (85%-80%). A similar pattern of opacity distribution was observed in the contralateral teeth. On smooth surfaces, opacities were more frequent in the regions closer to the occlusal surface than to the cervical one. Conclusion: MIH opacities were mostly present on occlusal, vestibular, and lingual/palatine surfaces, respectively. There is a possibility that the occurrences are in accordance with the chronology of dental formation.

A minimal interventive protocol using antimicrobial photodynamic therapy on teeth with molar incisor hypomineralization: A case report.

Molar incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that occurs during the mineralization phase. Patients with MIH have increased risk of caries, hypersensitivity, and restoration failures. The present case report describes the treatment of a 10-year-old patient exhibiting two teeth with atypical carious lesions. A minimal interventive protocol was instituted combining antimicrobial photodynamic therapy and the selective chemical-mechanical removal of the carious tissue using the product Papacárie Duo®. This protocol is promising for the decontamination and control of hypersensitivity in teeth with MIH.

Development of undergraduate students' diagnostic accuracy for the classification of molar incisor hypomineralization.

INTRODUCTION: One of the major difficulties with respect to molar incisor hypomineralization (MIH) is its classification and differentiation from other enamel development defects (EDDs). The aim of this study was to evaluate diagnostic accuracy in dental students to classify MIH as well as its differentiation from other EDDs by combining conventional theoretical classes and e-learning-assisted pre-clinical practices. METHODS: In this one-group pre-test and post-test study, 59 second-year students assessed 115 validated photographs using the MIH Index on the Moodle learning platform. This index assesses the clinical features and extent of MIH, differentiating it from other EDDs. Students received automatic feedback after the pre-test. Two weeks later, students re-evaluated the same photographs. Both pairwise accuracy and overall diagnostic accuracy were estimated and compared for pre- and post-testing, with the area under the curve AUC, along with 95% confidence intervals (95% CI). RESULTS: The lowest diagnostic accuracy was for the ability to discriminate between white or cream-coloured demarcated opacities and hypomineralization-type defect that is not MIH. The overall pre-test accuracy was AUC = 0.83 and increased significantly post-test to AUC = 0.99 (p < .001). The overall accuracy to discriminate the extent of the lesion also increased significantly post-test (p < .001). CONCLUSION: Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

Relationship between cariogenic bacteria and molar incisor hypomineralization in Brazilian schoolchildren.

Background: Teeth with defects in their structure, such as the ones affected by molar-incisor hypomineralization (MIH), are more susceptible to carious lesions. Caries is a complex and multifactorial disease highly prevalent in childhood. The present research evaluated the relationship between the stages of MIH and cariogenic bacteria in children. Methods: After examining 566 schoolchildren, four groups of 10 children each were formed: healthy (G1), mild MIH (G2 and G3), and severe MIH + caries (G4). Dental biofilm was assessed to quantify Streptococcus mutans (SM) and Lactobacillus spp. (LB) using real-time polymerase chain reaction (RT-PCR). Results: LB counting in biofilm samples of healthy children (G1) and those with mild MIH characterized by white opacities (G2) were not significantly different. The same happened when the ones with yellow opacities (G3) were compared with severe MIH + caries (G4) (P>0.05). The post hoc Tukey test proved that G4 had greater levels of SM and LB when compared with G2 (P<0.05); however, the control group did not diverge from the others considering SM (P>0.05). Increased LB enhanced the severity of MIH [rate ratio (RR): 7.706; P=0.035]. Conclusions: LB was influenced by different degrees of MIH and the presence of caries and could guide clinical decisions and patients' recommendations to prevent carious lesions in MIH children.

Association between psychological factors and molar-incisor hypomineralization: A cross-sectional study.

BACKGROUND: Molar-incisor hypomineralization (MIH) is a developmental enamel defect characterized by opacities from white to brownish color. A suspected multifactorial etiology has been suggested, whereas psychological factors during pregnancy have only been limitedly analyzed. AIM: We assessed the association between stress, depression, and anxiety in pregnancy and the presence of MIH in children at a later age. DESIGN: Using a cross-sectional Web-based questionnaire, we included 384 mothers who had children aged 6 and 12 years from Pasto, Colombia. Data were collected between October 2021 and March 2022. Sociodemographic variables; maternal and child factors related to prenatal, natal, or postnatal problems; and psychological factors such as stress and symptoms of anxiety and depression in pregnancy were inquired. Utilizing photographs depicting MIH lesions, mothers assessed their child's MIH status. A directed acyclic graph (DAG) analysis was performed to create causal assumptions, and logistic regression models were estimated to evaluate these assumptions. p-value was set at p < .05. RESULTS: The prevalence of MIH was 33.3%; 12.8% of the participants exhibited hypomineralization in both molars and incisors. DAG analysis and logistic regression models determined that MIH (present or not) was associated with symptoms of maternal depression (ORadj = 3.26, 95% CI: 1.92-5.52, p < .001), and MIH (both molars and incisors) was associated with symptoms of maternal anxiety (ORadj = 3.49, 95% CI: 1.80-6.76, p < .001). CONCLUSION: Psychological factors, among others, were significantly associated with the presence of MIH.

Influence of genetics on the occurrence of enamel hypomineralization affecting permanent and primary teeth: A scoping review.

BACKGROUND: Molar incisor hypomineralization (MIH) is prevalent worldwide and is a challenge for clinicians who provide oral care to children. Molar incisor hypomineralization has been considered a multifactorial disturbance that results from a combination of environmental and genetic factors. AIM: This scoping review followed the Joanna Briggs Institute protocol and aimed to identify the available evidence of the genetic influence on the etiology of MIH. DESIGN: The search strategy was conducted in multiple databases, including PubMed, BVS, Embase, Web of Science, and Scopus. Two trained reviewers, requiring a third reviewer in case of disagreements, collected evidence. RESULTS: Of 563 retrieved studies, 17 were included in the review. From 14 studies performed in humans, 10 investigated DNA polymorphisms, one analyzed DNA methylation, one aimed model of inheritance, and two focused on the phenotype in twins or in the family. Three animal studies were based on the null expression of genes. CONCLUSION: This scoping review, based on the studies that used different methodologies, reinforces the hypothesis of a genetic contribution to the multifactorial etiology of MIH. The available data are limited in terms of size and origin of the samples. Hence, further genetic studies are still required.

Comparison between two molar incisor hypomineralization detection criteria in epidemiological surveys.

BACKGROUND: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. AIM: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH-Severity Scoring System (MIH-SSS) in classifying and diagnosing MIH. DESIGN: This cross-sectional study assessed the indices in a homogeneous group of 680 6- to 10-year-old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. RESULTS: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH-SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH-SSS (chi-squared test; p < .01). The MIH-SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p < .05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. CONCLUSION: All systems effectively diagnosed MIH and its characteristics.

Pre- and perinatal exposures associated with molar incisor hypomineralization: Birth cohort, Brazil.

OBJECTIVE: To analyze prenatal and perinatal stressors associated with molar incisor hypomineralization (MIH) in adolescents. METHODS: Prospective cohort study collected prenatal (socioeconomic status, maternal age, number of prenatal visits, smoking, obesity during pregnancy, abortion history, gestational hypertension) and perinatal stressors (type of delivery, gestational age, birth weight, intensive care unit-ICU at birth). The outcome was MIH at 18-19 years follow-up (n = 590). MIH was defined according to the Ghanim criteria - Model I. We performed a sensitivity analysis, including opacities demarcated in index tooth, incisive or molars, Model II. Through structural equation modeling, we analyzed direct and mediating pathways between multiple stressors with outcomes. RESULTS: MIH was observed in 15.25% (n = 90), and opacities demarcated in any index tooth were observed in 22.8% of adolescents (n = 135). In Model I, no stressor explained MIH significantly, although we watched high standardized coefficients (SC) for low birth weight (SC = 0.223, p = 0.147), lower gestational age (SC = 0.351; p = 0.254), and ICU admission (SC = 0.447, p = 0.254). In Model II, advanced maternal age (SC = 0.148; p < 0.05) and not undergoing prenatal care (SC = 0.384, p < 0.03) explained opacities demarcated in incisors or molars. CONCLUSION: Advanced maternal age and not undergoing prenatal care were associated with MIH lesion-like in incisors or molars.

Molar-incisor hypomineralization in a cohort of individuals born with cleft lip and palate.

OBJECTIVE: This study aimed to investigate the frequency of molar-incisor hypomineralization (MIH) in individuals born with cleft lip and or cleft palate. SETTINGS AND SAMPLE: Three hundred eighty-six individuals born with cleft lip and/or palate before orthodontic treatment. METHODS: All the individuals were submitted to a clinical examination and intraoral standardized photos. The registration of MIH was taken by two orthodontists and analysed in association with the cleft type and laterality. The Kruskal-Wallis test and the regression test were used to compare the frequency of molars and incisors affected according to cleft type and laterality, sex and age. RESULTS: We found a frequency of 67.87% of MIH in the studied sample. The frequency varied from 25% (in individuals born with cleft palate) to 77% in individuals born with bilateral cleft lip and palate). The number of affected molars was statistically different depending on cleft type and laterality (P < .001- Kruskal-Wallis test). Differences were found between individuals born with unilateral cleft lip and palate and unilateral cleft lip and alveolus (P = .03), and with isolated cleft palate (P = .03), and between individuals born with bilateral cleft lip and palate and born with unilateral cleft lip and alveolus (P = .01), and cleft palate (P = .01). Sex (P = .21) and age (P = .36) had no influence on the frequency of MIH. A positive correlation was found between the number of molars affected and incisors affected (P < .001). CONCLUSION: Individuals born with cleft lip and palate have a higher frequency of MIH, and the complexity of cleft type was associated with the number of affected molars.

Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren.

PURPOSE: Data about molar-incisor hypomineralization (MIH) prevalence and its severity remains limited for some Latin American countries. Furthermore, its association with socioeconomic status (SES) is still unclear. Thus, this study aims to determine the prevalence and severity of MIH in Santiago, Chile and explore its association with SES. METHODS: A cross-sectional study with schoolchildren between 6 and 12 years was conducted. Children were evaluated using the European Academy of Paediatric Dentistry to diagnose MIH, and the Mathu-Muju and Wright criteria to determine its severity. RESULTS: A total of 1,270 children were included. The MIH prevalence was 12.8% without association with gender (p = 0.609). Prevalence was higher among schoolchildren ages 8 and 9 (p = 0.002), and in lower SES (p = 0.007). MIH mild cases were the most prevalent (63%), and severity was not related to gender (p = 0.656), age (p = 0.060), or SES (p = 0.174). CONCLUSIONS: The prevalence of MIH in the province of Santiago, Chile is 12.8% and was found to have a higher incidence in 8-9-year-old students and among those categorized by low SES. Furthermore, MIH prevalence was associated with low SES. IMPLICATIONS: Public health policies to address MIH in Chile should start with schoolchildren aged 8 to 9, and with low SES.

Dental caries prevention in pediatric patients with molar incisor hypomineralization: a scoping review.

This scoping review aims to summarize the available evidence on strategies employed in preventing caries in patients with molar incisor hypo-mineralization (MIH). MIH refers to an enamel defect involving opacities, and sometimes post-eruptive degradation due to enamel porosity; resulting in outcomes ranging from a mild atypical caries to severe coronary destruction. A systematic review was conducted for literature in PubMed, Cochrane Library, Epistemonikos and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). The search was aimed at studies published between January 2010 and February 2022. Data were independently selected and extracted. 989 studies were found from the systematic search and 8 studies met the eligibility criteria. Most studies evaluated remineralization and cariogenic risk, both of which are crucial elements in caries prevention, as well as decreased sensitivity. The included studies investigated fluoride varnish, dental sealants, giomers, casein, and Icon as preventative methods for dental caries. Several methods for preventing dental caries in paediatric patients with MIH exist, but more research is needed to determine their effectiveness and safety. Any preventive intervention should consider the etiological aspects of the disease, the risk of caries, the type and extent of lesions, hypersensitivity level and patient's age. Collaboration between patients and carers is critical for disease diagnosis and caries prevention.

Etiological Factors of Molar Incisor Hypomineralization: A Systematic Review and Meta-Analysis.

Molar incisor hypomineralization (MIH) is a defect of the dental enamel that predominantly affects first molars and permanent incisors. Identifying the significant risk factors associated with MIH occurrence is essential for the implementation of prevention strategies. The purpose of this systematic review was to determine the etiological factors associated with MIH. A literature search was carried out from six databases until 2022; it covered pre-, peri-, and postnatal etiological factors. The PECOS strategy, PRISMA criteria, and the Newcastle-Ottawa scale were used, and 40 publications were selected for qualitative analysis as well as 25 for meta-analysis. Our results revealed an association between a history of illness during pregnancy (OR 4.03 (95% CI, 1.33-12.16), p = 0.01) and low weight at birth (OR 1.23 (95% CI, 1.10-1.38), p = 0.0005). Furthermore, general illness in childhood (OR 4.06 (95% CI, 2.03-8.11), p = 0.0001), antibiotic use (OR 1.76 (95% CI, 1.31-2.37), p = 0.0002), and high fever during early childhood (OR 1.48 (95% CI, 1.18-1.84), p = 0.0005) were associated with MIH. In conclusion, the etiology of MIH was found to be multifactorial. Children with health disorders in the first years of life and those whose mothers underwent illnesses during pregnancy might be more susceptible to MIH.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH).

AIM: The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. METHODS: For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). RESULTS: MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. CONCLUSION: No association was found between dental fear and dental hypersensitivity in children with MIH.

Determination of dental caries, molar-incisor hypomineralization, and oral health-related quality of life in schoolchildren: A structural equation modeling approach.

BACKGROUND: Some oral conditions can have psychosocial consequences that affect children's daily life and well-being. AIM: To create a structural model for the determination of dental caries, molar-incisor hypomineralization (MIH), and the impact of these conditions and socioeconomic status on schoolchildren's oral health-related quality of life (OHRQoL). DESIGN: A representative cross-sectional study was conducted in Lavras, Brazil, with 1181 female and male schoolchildren 8-9 years of age. OHRQoL was measured using the Brazilian version of the CPQ8-10. Clinical examinations were performed by a calibrated dentist for the diagnosis of dental caries (WHO) and MIH (EAPD). Parents/caregivers answered questionnaires addressing the child's medical history and socioeconomic status. Data were analyzed using structural equation modeling. RESULTS: The model revealed that greater MIH severity (ß = .874; p < .001) and worse socioeconomic status (ß = -.060; p = .001) were associated with a greater number of teeth with caries experience. The higher the number of teeth with caries experience (ß = .160; p = .007) and worse socioeconomic status (ß = -.164; p < .001), the greater the negative impact on OHRQoL. CONCLUSION: The model created showed that dental caries and socioeconomic status had a direct negative impact on the OHRQoL of schoolchildren and MIH had an indirect impact mediated by the occurrence of caries experience.

[Effect of molar incisor hypomineralization on oral health-related quality of life in children and adolescents: a systematic review]. / Efecto de la hipomineralización incisivo molar en la calidad de vida relacionada con la salud bucal de niños y adolescentes: una revisión sistemática.

Introduction: Hypersensitivity, altered dental appearance and fractures are common problems in molar incisor hypomineralization that generate functional and socio-emotional problems. Objective: to evaluate the effect of MIH on oral health-related quality of life in children and adolescents. Materials and methods: A systematic bibliographic search was carried out in electronic databases (Pubmed, Epistemonikos, Dentistry & Oral Sciences Source and Virtual Health Library). Observational studies in English or Spanish conducted between 2016-2022 that evaluated the quality of life of children and adolescents with molar incisor hypomineralization were identified. Most studies were of good methodological quality. Results: Of 96 identified studies, thirteen were included in the synthesis. The most frequent diagnostic criterion for hypomineralization of molar incisors was the index of the European Academy of Pediatric Dentistry and nine studies reported the severity of the disease. The most widely used scale to measure quality of life was the Child Perception Questionnaire (CPQ). According to the children's perception, the most affected dimensions were "Oral Symptoms" and "Emotional Well-Being", according to the parents they were "Oral Symptoms" and "Functional Limitations". Girls with molar incisor hypomineralization had worse oral health-related quality of life. Conclusions: The negative effect of molar incisor hypomineralization on children's oral health-related quality of life seems to vary between the perception of parents and children.