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Purpose In addition to molar incisor hypomineralisation, the occurrence of enamel hypomineralisation in the primary dentition has become increasingly important in recent years. Hypomineralised second primary molar (HSPM) is defined as hypomineralisation of systemic origin affecting from one to all four second primary molars. Some years ago, the “Würzburg concept” was introduced, which proposed a grading of MIH findings (MIH treatment need index) in combination with an appropriate treatment plan depending on the severity of the affected tooth. Recently, this concept was updated and new treatment approaches have been added. However, currently, the concept solely addresses the treatment plan for permanent teeth. As there is a need to expand its scope to encompass primary teeth and, consequently, HSPM, this paper seeks to develop the second component of the Würzburg concept, the treatment plan, for the primary dentition in response to the increased focus on the disease in recent years. Although the evidence base for the different treatment options is still weak, there is a need for guidance for clinicians in their day-to-day practice. Methods The authors conducted a comprehensive review of the literature, encompassing clinical and laboratory studies along with published guidelines. Results The treatment plan of the HSPM Würzburg concept contains prophylactic and regenerative aspects, non-invasive interventions, temporary and permanent restorative techniques, and extraction. Conclusions The intention is to provide practical guidance to practitioners, acknowledging the necessity for further validation through clinical trials.

Background Despite clear assessment criteria, studies of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) are marked by inconsistency in outcome measurements. This has detracted from meaningful comparisons between studies and limited interpretation. Aim To provide a comprehensive manual as a companion to assist researchers in planning epidemiological studies of MIH and HSPM, with particular reference to outcome measurement. Methods This manual begins with a succinct review of the clinical problems and evidence for management of the conditions. The subsequent sections guide researchers through diagnosis of MIH and HSPM and implementation of both the long and short forms of a recently proposed grading system. MIH and HSPM can often be confused with fluorosis, enamel hypoplasia, amelogenesis imperfecta, and white spot lesions but can be distinguished by a number of unique clinical features. Based on the grading system, a standardised protocol is proposed for clinical examinations. Intra and inter-examiner reliability is of key importance when outcome measurement is subjective and should be reported in all epidemiological studies of MIH. The manual concludes with an exercise forum aimed to train examiners in the use of the grading system, with answers provided. Conclusion The use of a standardised protocol, diagnostic and grading criteria will greatly enhance the quality of epidemiological studies of MIH.

Background Molar-incisor hypomineralization (MIH) results in teeth that are highly prone to dental caries, sensitive to temperature changes and challenging to restore due to the atypical cavities or coronal deformation. Objectives This study aimed to assess the prevalence of MIH, the characteristics of affected first permanent molars (FPMs), and the relationship between MIH and hypomineralized second primary molars (HSPM) among primary school children in Jeddah, Saudi Arabia. Methods Jeddah City was divided into three regions, and 12-schools were randomly selected through stratified sampling. The inclusion criteria involved 7 to 9 years old children who had at least one erupted FPM. The caries status was assessed using the World Health Organization (WHO) indices dmft/DMFT. The assessment of MIH was conducted based on the criteria established by the European Academy of Pediatric Dentistry at their meeting in Athens in 2003. Results A total of 2,019 children participated with an MIH prevalence of MIH 18.3% (369 patients), and an HSPM prevalence of 1.8% (36 patients). The mean DMFT/dmft index was 5.99 ± 4.08. White creamy opacities were the most common presentation of FPMs and HSPM (about 80% of MIH-affected FPMs). A statistically significant association was found between MIH and HSPM and increased odds ratio of MIH with HSPM ( P  < 0.001, OR = 5.96, and 95% CI: 5.3–6.57). Conclusion The prevalence of MIH was higher than compared to the reported Middle East studies. The white creamy opacities were the most common presentations of MIH. A strong association existed between MIH and HSPM and an increased risk of having MIH when the child was found to have HSPM.

With the development of the European Academy of Paediatric Dentistry (EAPD) judgment criteria, there has been increasing interest worldwide in investigation of the prevalence of demarcated opacities in tooth enamel substance, known as molar–incisor hypomineralisation (MIH). However, the lack of a standardised system for the purpose of recording MIH data in epidemiological surveys has contributed greatly to the wide variations in the reported prevalence between studies. The present publication describes the rationale, development, and content of a scoring method for MIH diagnosis in epidemiological studies as well as clinic- and hospital-based studies. The proposed grading method allows separate classification of demarcated hypomineralisation lesions and other enamel defects identical to MIH. It yields an informative description of the severity of MIH-affected teeth in terms of the stage of visible enamel destruction and the area of tooth surface affected (i.e. lesion clinical status and extent, respectively). In order to preserve the maximum amount of information from a clinical examination consistent with the need to permit direct comparisons between prevalence studies, two forms of the charting are proposed, a short form for simple screening surveys and a long form desirable for prospective, longitudinal observational research where aetiological factors in demarcated lesions are to be investigated in tandem with lesions distribution. Validation of the grading method is required, and its reliability and usefulness need to be tested in different age groups and different populations.

Aim The aim of the present cross-sectional study was to assess and compare the prevalence of MIH among 6–12-year-old school children living either in a rural area of Central Hesse (Germany) or in the city of Frankfurt on the Main (Germany). A possible association between hypomineralised second primary molars (HSPM) and MIH was investigated. Furthermore, the MIH prevalence data of the rural area were compared with those of a previous study conducted in this area in the school year 2002/2003. Methods In the school year 2014/2015, 2103 children (6–12 years of age) were examined during the annual school-based dental examinations prescribed by law at nine schools in the rural area of Central Hesse (LDK) and five schools in the city of Frankfurt on the Main (Ffm). Eight previously calibrated dentists working for the public healthcare authorities assessed the prevalence of HSPM/MIH (EAPD criteria/severity scale by Wetzel and Reckel) and the caries experience (dmft/DMFT). Results The prevalence of HSPM/MIH amounted 3.2%/9.4% in LDK and 2.9%/17.4% in Ffm. In the majority of cases, children with MIH had demarcated opacities. In LDK, hypomineralised first permanent molars were most commonly affected by severity degree 2, whereas in Ffm, severity degree 1 was predominant. Children suffering from HSPM had an odds ratio of 11.32 (95% CI: 6.73–19.03) for having MIH as well. Compared with the results of 2002/2003 in LDK (prevalence of MIH 5.9%), the MIH prevalence increased by 3.5% in the rural area. All in all, the caries experience among children under investigation was low (DMFT 0.14–0.15). Significance MIH may be diagnosed in school children living in different areas of Germany with regional variations (rural-urban comparison). The presence of HSPM is of predictive value for MIH. The increasing number of hypomineralised first permanent molars over 12 years of time in the rural area indicates a need for further investigation on the aetiology of MIH.

Background:  Malnutrition is well-known to yield high morbidities and it has pre-eruptive and post-eruptive consequences. The objective of the study was to evaluate the prevalence of Hypomineralized Second Primary Molars (HSPM), Molar Incisor Hypomineralization (MIH) and dental caries in malnourished children, as well as addressing the relation between types of malnutrition and the dental morbidities. Methods: This is a cross sectional analytical study. A consecutive sample of 54 malnourished cases aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University across 6 months period were examined for HSPM, MIH - using the  European Academy of Pediatric Dentistry criteria - and dental Caries using def/ DMF indices. Outcomes were the presence or absence of MIH and HSPM and their levels measured as percentage as well as Caries Indices. Exposures were types of malnutrition and the socioeconomic status.   Results :   The mean age of study participants was 7.10 ± 1.34 years. HSPM and MIH were found in 47.2% and 45.2% of the study participants respectively, while dental caries was observed in 83% and 64.3% for primary and permanent teeth respectively. There was co-occurrence between HSPM and MIH in 39% of the cases. HSPM level was significantly different in various types of malnutrition. It showed significant difference between the stunted group (median HSPM of 14.2%) and the overweight or obese group (median HSPM of 0.0%) (P value 0.01). MIH level showed significant differences between the stunted group (median MIH of 19.4%) and overweight or obese group (median MIH of 0.0%) (p value 0.001), as well as between the stunted group (median MIH of 19.4%) and wasted group (median MIH of 0.0%) (p value 0.025). Conclusions : Malnourished children have high prevalence of dental abnormalities. HSPM could expect the presence of MIH.

Objective The main objective of this study was to estimate the prevalence of molar incisor hypomineralisation (MIH), an alteration of tooth enamel with an estimated worldwide prevalence rate of 14%, among children using primary care services in the Community of Madrid, Spain. Materials and methods This was a descriptive, cross-sectional and multicentre study. After calibrating all researchers and following the diagnostic criteria of the European Academy of Paediatric Dentistry (EAPD), children aged between 8 and 16 years who were users of the dental services at 8 primary oral health units of the Madrid Health Service (SERMAS) were included. The children underwent a dental examination, and the parents were asked to complete a questionnaire. Results The prevalence of MIH was 28.63% (CI: 24.61–32.65%). The age cohorts most affected by MIH were 8 years (21.4%) and 11 years (20.7%). The presence of MIH was greater among girls (85; 60.71%) than among boys (55; 39.28%). The mean number of affected teeth per patient was 4.46 ± 2.8. The most frequently affected molar was the upper right first molar (74.3%), and the upper left central incisor was the most affected incisor (37.85%). Opacities were the defects most frequently recorded (63.57%). Conclusions The prevalence of MIH in this study is the highest of all relevant studies conducted in Spain.

Molar Incisor Hypomineralisation (MIH) is defined as a qualitative demarcated enamel hypomineralisation defect of tooth enamel affecting at least one first permanent molar (FPM), often affecting permanent incisors. More recently, the term Hypomineralised Second Primary Molar (HSPM) was used to describe similar defects affecting second primary molars. Our observational study aimed at determining HSPM and MIH frequencies in a medieval and early-modern-age population population (Sains-en-Gohelle, France, 7th − 17th centuries) and compare it to the current worldwide and French prevalence values. To date, there are no other studies on this subject in France. European studies have been published, but the diagnosis of these pathologies is based solely on a visual examination. Our study differs from others by using objective diagnostic. microtomography and X-ray fluorescence. The use of these diagnostic methods allows differentiation between hypomineralised and taphonomic lesions. The frequencies of MIH and HSPM were, respectively, 12.3% and 13.3%. In fact, there were 10 individuals with at least one first permanent molar affected by MIH amongst the 81 individuals with at least one first permanent molar present, and 15 individuals with at least one second primary molar affected by HSPM among the 113 individuals with at least one second primary molar present.The presence of MIH and HSPM in ancient populations with frequencies respectively equivalent and higher than current worldwide averages renews the debate and questioning about the aetiological factors of these pathologies.

Purpose The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. Methods The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18–22 and 32–36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. Results Among the children (7–9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18–22 and the number of affected teeth among those with MIH at 7–9 years (adjusted RR = 1.82, 95% CI 1.13–2.93). Conclusion Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7–9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

Background/Objectives: This systematic review aims to investigate the potential association between vitamin D levels and the occurrence of developmental enamel defects (DDE) in children, including conditions like molar–incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPMs). DDEs, which occur during tooth development, can result in significant aesthetic and functional issues, and their exact etiology remains unclear, with both genetic and environmental factors contributing. Among environmental factors, vitamin D deficiency has been proposed as a possible risk factor, given its role in enamel mineralization. Methods: A thorough literature search was conducted in PubMed, Scopus, and Embase. The search strategy included terms such as “vitamin D”, “vitamin D deficiency”, “developmental defects of enamel”, “enamel hypoplasia”, “molar-incisor hypomineralization”, and “hypomineralized second primary molars”. Studies were included if they were original human observational research (cohort, case–control, or cross-sectional) conducted in children under 18 years of age or involving maternal–child cohorts. Ten studies were included in the analysis, with a total of 15,891 participants. The primary data extracted from the selected studies included the following: study design, participants’ age, sample size, vitamin D status in relation to developmental defects of enamel, and statistical significance Results: The findings were mixed, with only a few studies suggesting a significant association between low vitamin D levels and the presence of DDEs. Specifically, one study found a link between insufficient maternal vitamin D levels during pregnancy and an increased number of teeth affected by MIH in children. However, the majority of the studies did not report a significant association. Conclusions: This review concludes that while there is some evidence to suggest a possible relationship between vitamin D and DDEs, more research is needed to confirm these findings and better understand the underlying mechanisms.