World Journal of Dentistry

Register      Login

VOLUME 15 , ISSUE 1 ( January, 2024 ) > List of Articles


Prenatal, Natal, and Postnatal Risk Factors Associated with Molar Incisor Hypomineralization: Case–control Study

Malini Venugopal, Nishna Thankappan, Vennila Chandran, Rohith Radhakrishna, Niveditha Kartha, Lekshmi Anand, Krupa R Robert, Gopika MS Nair

Keywords : Molar Incisor hypomineralization, Perinatal history, Risk factors

Citation Information : Venugopal M, Thankappan N, Chandran V, Radhakrishna R, Kartha N, Anand L, Robert KR, Nair GM. Prenatal, Natal, and Postnatal Risk Factors Associated with Molar Incisor Hypomineralization: Case–control Study. World J Dent 2024; 15 (1):36-43.

DOI: 10.5005/jp-journals-10015-2344

License: CC BY-NC 4.0

Published Online: 20-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: The aim of the study is to investigate the association of molar-incisor hypomineralization (MIH) with prenatal, natal, and postnatal factors among children aged 7–12 years. Materials and methods: It is a case–control study. The participants were first examined for the diagnosis of MIH as per European Academy of Paediatric Dentistry (EAPD) criteria 2003. A structured closed-ended questionnaire including potential etiological factors during prenatal, natal, and postnatal periods was constructed. A face-to-face interview was conducted with the mother, and the mother answered yes/no. Proposed risk factors were collected from exhaustive literature reviews. Results: Prenatal risk factors were found to have a strong correlation with MIH. Among these, hypertension, chickenpox, and excessive consumption of medications showed a strong correlation. Thyroid, excessive vomiting, and abortion also showed a positive correlation. Low birth weight among natal factors, pneumonia, tonsillitis, prolonged breastfeeding, and multiple hospital admissions among postnatal factors were shown to have a strong correlation with MIH. Conclusion: In the present study, the presence of prenatal and postnatal risk factors was significantly associated with a higher risk of developing MIH. A significantly higher prevalence of MIH was seen in children belonging to the lower middle socioeconomic section of the study population. Clinical significance: It's important to identify MIH groups at risk to reach an early diagnosis so that prevention can be initiated as soon as possible. MIH-affected teeth are 10 times more prone to treatment needs than normal counterparts. Awareness among pediatricians and gynecologists is highly recommended as adequate care for pregnant women and children during the first years of life is the key to the prevention of MIH. The dental follow-up of children who are exposed to risk factors during the perinatal stages is suggested for the timely diagnosis, preventive therapies, and treatment of MIH.

  1. Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res 2001;35(5):390–391. DOI: 10.1159/000047479
  2. Lygidakis NA, Garot E, Somani C, et al. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent 2022;23(1):3–21. DOI: 10.1007/s40368-021-00668-5
  3. Suga S. Enamel hypomineralisation viewed from pattern of progressive mineralisation of human and monkey developing enamel. Adv Dent Res 1989;3:188–198. DOI: 10.1177/08959374890030021901
  4. Jeremias F, Koruyucu M, Küchler EC, et al. Genes expressed in dental enamel development are associated with molar-incisor hypomineralization. Arch Oral Biol 2013;58(10):1434–1442. DOI: 10.1016/j.archoralbio.2013.05.005
  5. Fatturi AL, Wambier LM, Chibinski AC, et al. A systematic review and meta-analysis of systemic exposure associated with molar incisor hypomineralization. Community Dent Oral Epidemiol 2019;47(5):407–415. DOI: 10.1111/cdoe.12467
  6. Beentjes VE, Weerheijm KL, Groen HJ. Factors involved in the aetiology of molar-incisor hypomineralisation (MIH). Eur J Paediatr Dent 2002;3(1):9–13. PMID: 12871011.
  7. Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update 2004;31(1):9–12. DOI: 10.12968/denu.2004.31.1.9
  8. Jalevik 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(1):24–32. DOI: 10.1046/j.0960-7439.2001.00318.x
  9. Portella PD, Menoncin BLV, de Souza JF, et al. Impact of molar incisor hypomineralization on quality of life in children with early mixed dentition: a hierarchical approach. Int J Paediatr Dent 2019;29(4):496–506. DOI: 10.1111/ipd.12482
  10. Elfrink ME, Ghanim A, Manton DJ, et al. Standardised studies on molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM): a need. Eur Arch Paediatr Dent 2015;16(3):247–255. DOI: 10.1007/s40368-015-0179-7
  11. Lopes LB, Machado V, Mascarenhas P, et al. The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis. Sci Rep 2021;11(1):22405. DOI: 10.1038/s41598-021-01541-7
  12. Emmatty TB, Eby A, Joseph MJ, et al. The prevalence of molar incisor hypomineralization of school children in and around Muvattupuzha, Kerala. J Indian Soc Pedod Prev Dent 2020;38(1):14. DOI: 10.4103/JISPPD.JISPPD_152_18
  13. Peedikayil FC, Tomy NC, Chandru TP, et al. Molar incisor hypomineralization in North Malabar: an epidemiological study. Dent Med Res 2019;7(2):40. DOI: 10.4103/dmr.dmr_10_19
  14. Elzein R, Chouery E, Abdel-Sater F, et al. Molar-incisor hypomineralisation in Lebanon: association with prenatal, natal and postnatal factors. Eur Arch Paediatr Dent 2021;22(2):283–290. DOI: 10.1007/s40368-020-00555-5
  15. Weerheijm KL, Duggal M, Mejare I, et al. Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent 2003;4(3):110–113. PMID: 14529329.
  16. Kumar G, Dash P, Patnaik J, et al. Socioeconomic status scale-Modified Kuppuswamy Scale for the year 2022. Int J Comm Dent 2022;10(1):1–6. DOI: 10.56501/intjcommunitydent.v10i1.26
  17. Mariam S, Goyal A, Dhareula A, et al. A case-controlled investigation of risk factors associated with molar incisor hypomineralization (MIH) in 8-12 year-old children living in Chandigarh, India. Eur Arch Paediatr Dent 2022;23(1):97–107. DOI: 10.1007/s40368-021-00665-8
  18. 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(3):139–144. PMID: 18844443.
  19. Whatling R, Fearne JM. Molar incisor hypomineralization: a study of aetiological factors in a group of UK children. Int J Paediatr Dent 2008;18(3):155–162. DOI: 10.1111/j.1365-263X.2007.00901.x
  20. Arrow P. Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia. Aus Dent J 2008;53(3):250–259. DOI: 10.1111/j.1834-7819.2008.00057.x
  21. Aine L, Backström MC, Mäki R, et al. Enamel defects in primary and permanent teeth of children born prematurely. J Oral Pathol Oral Med 2000;29(8):403–409. DOI: 10.1034/j.1600-0714.2000.290806.x
  22. Aggarwal R, Upadhyay M, Deorari AK, et al. Hypocalcemia in the newborn. Indian J Pediatr 2001;68(10):973–975. DOI: 10.1007/BF02722599
  23. 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):318–328. DOI: 10.1016/j.jds.2018.05.002
  24. Basso AP, Ruschel HC, Gatterman A, et al. Hipomineralização molar-incisivo. Rev Odonto Cienc 2007;22(58):371–376. PMID: 487220.
  25. Lygidakis NA, Wong F, Jälevik B, et al. 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(2):75–81. DOI: 10.1007/BF03262716
  26. Butera A, Maiorani C, Morandini A, et al. Assessment of genetical, pre, peri and post natal risk factors of deciduous molar hypomineralization (DMH), hypomineralized second primary molar (HSPM) and molar incisor hypomineralization (MIH): a narrative review. Children (Basel) 2021;8(6):432. DOI: 10.3390/children8060432
  27. Serna C, Vicente A, Finke C, et al. Drugs related to the etiology of molar incisor hypomineralization: a systematic review. J Am Dent Assoc 2016;147(2):120–130. DOI: 10.1016/j.adaj.2015.08.011
  28. Crombie F, Manton D, Kilpatrick N. Aetiology of molar-incisor hypomineralization: a critical review. Int J Paediatr Dent 2009;19(2):73–83. DOI: 10.1111/j.1365-263X.2008.00966.x
  29. Elsori DH, Hammoud MS. Vitamin D deficiency in mothers, neonates and children. J Steroid Biochem Mol Biol 2018;175:195–199. DOI: 10.1016/j.jsbmb.2017.01.023
  30. van der Tas JT, Elfrink MEC, Heijboer AC, et al. Foetal, neonatal and child vitamin D status and enamel hypomineralization. Community Dent Oral Epidemiol 2018;46(4):343–351. DOI: 10.1111/cdoe.12372
  31. Schwarz C, Leichtle AB, Arampatzis S, et al. Thyroid function and serum electrolytes: does an association really exist? Swiss Med Wkly 2012;17:142. DOI: 10.4414/smw.2012.13669
  32. Alaluusua S. Aetiology of molar-incisor hypomineralisation: a systematic review. Eur Arch Paediatr Dent 2010;11(2):53–58. DOI: 10.1007/BF03262713
  33. Jan J, Vrbic V. Polychlorinated biphenyls cause developmental enamel defects in children. Caries Res 2000;34(6):469–473. DOI: 10.1159/000016625
  34. Fagrell TG, Ludvigsson J, Ullbro C, et al. Aetiology of severe demarcated enamel opacities–an evaluation based on prospective medical and social data from 17,000children. Swed Dent J 2010;35(2):57–67. PMID: 21827015.
  35. Alaluusua S, Lukinmaa PL, Koskimies M, et al. Developmental dental defects associated with long breast feeding. Eur J Oral Sci 1996;104(5-6):493–497. DOI: 10.1111/j.1600-0722.1996.tb00131.x
  36. Lygidakis NA, Dimou G, Marinou D. Molar-incisor-hypomineralisation (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors. Eur Arch Paediatr Dent 2008;9(4):207–217. DOI: 10.1007/BF03262637
  37. Ghanim A, Manton D, Bailey D, et al. Risk factors in the occurrence of molar-incisor hypomineralization amongst a group of Iraqi children. Int J Paediatr Dent 2013;23(3):197–206. DOI: 10.1111/j.1365-263X.2012.01244.x
  38. Balmer R, Toumba J, Godson J, et al. The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation. Int J Paed Dent 2012;20(22):250–257. DOI: 10.1111/j.1365-263X.2011.01189.x
  39. Juárez-López MLA, Salazar-Treto LV, Hernández-Monjaraz B, et al. Etiological factors of molar incisor hypomineralization: a systematic review and meta-analysis. Dent J (Basel) 2023;11(5):1–16. DOI: 10.3390/dj11050111
  40. Garot E, Rouas P, Somani C, et al. An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. Eur Arch Paediatr Dent 2022;23(1):23–38. DOI: 10.1007/s40368-021-00646-x
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.