THE SOCIAL CONTEXT OF MOLAR-INCISOR HYPOMINERALIZATION AND CARIE EXPERIENCE IN CHILDHOOD LITERATURE REVIEW

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UNIVERSIDADE FEDERAL DE MINAS GERAIS 
 
 
 
LAURA GISMONTI DE ARAUJO GAUDÊNCIO 
 
 
 
 
 
 
 
 
 
 
 
 
THE SOCIAL CONTEXT OF MOLAR-INCISOR HYPOMINERALIZATION AND 
CARIE EXPERIENCE IN CHILDHOOD: LITERATURE REVIEW 
 
 
 
 
 
 
 
 
 
 
 
 
 
BELO HORIZONTE 
2021 
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The Social Context of Molar-Incisor Hypomineralization and Carie Experience in 
Childhood: Literature Review 
 
Molar-Incisor Hypomineralization (MIH) is defined as an enamel defect that involves 
one to four first permanent molars and may involve the permanent incisors. This clinical 
concept was developed by Weerheijm et al (2001). The clinical aspects observed for 
this condition are that the enamel is softer and more porous with white, yellow or brown 
demarcated opacities that could be matched with enamel breakdown (WEERHEIJM, 
2003). The development of MIH happens from the prenatal period until the first 3 years 
of age, when the first molar mineralization occurs, and is characterized by reduction in 
the deposit of minerals, as it affects the amelogenesis maturation phase (WEERHEIJM 
et al., 2001). MIH is a recent condition with unknown etiology, the majority of the 
studies are recent, are have not been conducted rigorously and the topic is 
underresearched, which is also why it is a challenge to dentists (AMERICANO et al., 
2017). 
 
A recent systematic review confirms the significant association between MIH and 
higher susceptibility to carie development in children affected by the condition 
(AMERICANO et al., 2017). This study analyzed seventeen studies that reported 
results on MIH and caries in the permanent dentition of children. All studies involved 
are available on PubMed and were published between January 2003 and November 
2015. The authors also expose the need of publishing well-designed studies about this 
association as the majority of the studies included presented low quality. All studies 
available are cross-sectional or cohort studies, in which a well-defined control group is 
not present, this makes it difficult to provide evidence of this association (AMERICANO 
et al., 2017). A retrospective study, such as a case-control study, has some limitations, 
but it was considered the only possible design to study the association between MIH 
and dental caries (DE AGUIAR GROSSI; CABRAL; LEAL, 2017). 
 
Many researches show significant association between MIH and higher prevalence of 
caries in children, this is because some tooth surfaces, such as pits and fissures, 
facilitate the development of early childhood caries (ECC) as they are risk areas for 
plaque retention and cariogenic bacterias adherence. As MIH-affected teeth are more 
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porous, they are more likely to progress to post-eruptive breakdown (PEB), a condition 
that exposes dentin, which facilitates the development of carious lesions. Moreover, in 
some cases, children have difficulty brushing their teeth due to sensitivity, which also 
induce carie development (DE AGUIAR GROSSI; CABRAL; LEAL, 2017). Studies 
reveal that “the likelihood that children with MIH return to the clinic for dental care is 
10.5 times greater than that of children without MIH” (JEREMIAS et al., 2013 apud 
KOTSANOS; KAKLAMANOS; ARAPOSTATHIS, 2005, p. 871). 
 
Despite having an uncertain etiology, the epidemiological knowledge of MIH is an 
essential indicator for determining actions to promote oral care (JEREMIAS et al., 
2013) and preventing disease progression and the development of carious lesions. 
Molar-incisor hypomineralization is a worldwide problem frequently associated with 
dental carie (AMERICANO et al., 2017), so, when preventing MIH, the chance of 
having caries decreases and a better quality of life quality is provided to children 
(KOTSANOS; KAKLAMANOS; ARAPOSTATHIS, 2005). 
 
The research of Oliveira, Chaves and Rosenblatt made in 2005 analyzes beyond the 
association between MIH and ECC, confirming a social context in these two conditions. 
The longitudinal study evaluated the influence of enamel defects (the most common is 
MIH) in the development of dental caries in low-socioeconomic children living in João 
Pessoa, Paraíba, Brazil, other variables such as feeding practices and oral health 
behaviors was also analyzed. This study reveal that ECC could be associated with 
malnutrition, low family income and infections in early life. Deprived children face the 
common biological risk factors and also the social risks to develop enamel defects. 
The authors observe that “children with enamel defects presented a risk of developing 
caries 15 times greater than those children without defects” (OLIVEIRA; CHAVES; 
ROSENBLATT, 2006, p. 301). In this study, night time breast-feeding was also defined 
as a complementary factor for MIH and ECC. 
 
The conclusion is that it is necessary to focus on low-socioeconomic communities 
because they face challenges that could aggravate the oral conditions, they have much 
less access to information and there is a lack of public policies to welcome the needy 
population (OLIVEIRA; CHAVES; ROSENBLATT, 2006). Even knowing with scientific 
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evidence that night time breast-feeding is a complementary factor for MIH and ECC, it 
is important to consider the social context, because early weaning may aggravate 
malnutrition, which causes more impacts on the incidence of enamel defects 
(ALVAREZ et al., 1993). The children’s cariogenic diet is also related to culture and 
poor education (OLIVEIRA; CHAVES; ROSENBLATT, 2006). 
 
All the articles referenced indicate the need of the government to pay attention to this 
condition and invest in oral public health. The policies should focus on making the 
environments comfortable for children to grow up with health rather than focus on the 
treatment of sick patients (OLIVEIRA; CHAVES; ROSENBLATT, 2006). To avoid or 
reduce the development of MIH, it is necessary to promote an interaction between 
doctors and dentists, because mothers should be advised and instructed about this 
condition since pre-natal care (JEREMIAS et al., 2013). Some authors believe that 
visits to the doctor are more frequent than to the dentist, so an integration of pediatric 
dentistry and medicine would help restoring the quality-of-life of children. (JEREMIAS 
et al., 2013). 
 
Patients with clinical symptoms should be referred by the doctor to the dentist so the 
dental intervention can occur as soon as possible. The integration of medicine and 
odontology is essential in this case. It is desirable that the professional involved in this 
treatment is a pediatric dentist, because he or she will have more knowledge about 
molar-incisor hypomineralization and more preparation to deal with children than a 
general dentist. (JEREMIAS et al., 2013). 
 
 
 
 
 
 
 
 
 
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REFERENCES: 
 
ALVAREZ, Johannes et al. A longitudinal study of dental caries in the primary teeth of 
children who suffered from infant malnutrition. Journal of dental research, v. 72, n. 
12, p. 1573-1576, 1993. 
 
AMERICANO, Gabriela Caldeira Andrade et al. A systematic review on the association 
between molar incisor hypomineralization and dental caries. International journal of 
paediatric dentistry, v. 27, n. 1, p. 11-21, 2017. 
 
DE AGUIAR GROSSI, Juliana; CABRAL, Renata Nunes; LEAL, Soraya Coelho. 
Caries experience in children with and without molar-incisor hypomineralisation: a 
case-control study. Caries research, v. 51, n. 4, p. 419-424, 2017. 
 
JEREMIAS, Fabiano et al. Dental caries experience and molar-incisor 
hypomineralization. Acta Odontologica Scandinavica, v. 71, n. 3-4, p. 870-876, 
2013. 
 
KOTSANOS, Nikolaos; KAKLAMANOS, Eleftherios; ARAPOSTATHIS, Konstantinos. 
Treatment management of first permanent molars in children with Molar-Incisor 
Hypomineralisation. European journal of paediatric dentistry, v. 6, n. 4, p. 179, 
2005. 
 
OLIVEIRA, Andressa;CHAVES, Ana Maria; ROSENBLATT, Aronitta. The influence of 
enamel defects on the development of early childhood caries in a population with low 
socioeconomic status: a longitudinal study. Caries research, v. 40, n. 4, p. 296-302, 
2006. 
 
WEERHEIJM, Karin; JALEVIK, Birgitta; ALALUUSUA, Satu. Molar-incisor 
hypomineralisation. Caries research, v. 35, n. 5, p. 390, 2001. 
 
WEERHEIJM, Karin L. et al. Molar incisor hypomineralisation (MIH). European 
Journal of Paediatric Dentistry, v. 4, p. 115-120, 2003.