Assessment of severity and mineral composition of saliva in schoolchildren with molar-incisor hypomineralization (MIH)

The aim of the study was to evaluate the severity of molar incisor hypomineralisation (MIH), related oral health and investigate salivary mineral composition. The study was conducted with 50 participants aged between 6–15 years who were effected with MIH and 50 without MIH. The International Caries Detection and Assessment System (ICDAS) scores, Decayed, Missing, Filled Teeth/Surface (DMFT/S), dft/s and gingival/plaque indices were evaluated. The pH, flow rate, buffering capacity and mineral composition of saliva was measured. “Student t” test, one-way analysis of variance in repeated measurements of groups, and Tukey multiplex in subgroup comparisons was used. Kruskal-Wallis, Mann-Whitney U, Wilcoxon and chi-square tests were used to analyze qualitative data and compare groups. A total of 100 children (57 females 43 males, mean age 10.12 ± 1.85) participated in the study. There was no difference between ICDAS, DMFT/S scores, but dft/s index values were statistically significant (p = 0.001). The simplified oral hygiene index of MIH patients were statistically higher, but no significant differences were found in modified gingival indices (p = 0.52). Although the salivary pH and flow rate of the patients in the study group were lower, the buffering capacity was higher than those in the control group, but no significant difference was observed (p = 0.64). The mean values of phosphorus, carbon and calcium content in the saliva samples of MIH patients were higher than those of patients without MIH, and this difference was low for phosphorus (p = 0.76) and carbon (p = 0.74), but significantly higher for calcium. To the best of our knowledge, this is the first study to evaluate the association between calcium, phosphate and carbon levels in saliva of children with MIH. The significantly high amount of calcium in the saliva of patients with MIH suggests that further investigations are needed.

Molar-incisor hypomineralisation; Saliva; Calcium; Phosphate; Carbon

[1] Weerheijm KL, Jälevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Research. 2001; 35: 390–391.

[2] Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European academy of paediatric dentistry policy document. European Archives of Paediatric Dentistry. 2022; 23: 3–21.

[3] Elzein R, Chouery E, Abdel-Sater F, Bacho R, Ayoub F. Molar-incisor hypomineralisation in Lebanon: association with prenatal, natal and postnatal factors. European Archives of Paediatric Dentistry. 2021; 22: 283–290.

[4] Pacheco Jiménez AD, Altamirano Mora VS, Dávila M, Montesinos-Guevara C. Dental caries prevention in pediatric patients with molar incisor hypomineralization: a scoping review. Journal of Clinical Pediatric Dentistry. 2023; 47: 9–15.

[5] Jianu MC, Muntean A, Mihălțan CI, Pacurar M, Munteanu A. Molar incisor hypomineralization: a review of etiology, diagnosis criteria and patterns considering EAPD criteria. Romanian Journal of Oral Rehabilitation. 2022; 14: 117–124.

[6] Hamdan MA, Abu-Ghefreh EA, Al-Abdallah M, Rajab LD. The prevalence and severity of molar incisor hypomineralization (MIH) among 8 year-old children in Amman, Jordan. Egyptian Dental Journal. 2020; 66: 1989–1997.

[7] Turkmen E, Ozukoç C. Impact of molar incisor hypomineralization on oral hygiene and gingival health in 8–15-years-old children. Australian Dental Journal. 2022; 67: S50–S56.

[8] Al-Nerabieah Z, AlKhouli M, Dashash M. Prevalence and clinical characteristics of molar-incisor hypomineralization in Syrian children: a cross-sectional study. Scientific Reports. 2023; 13: 8582.

[9] Garot E, Rouas P, Somani C, Taylor GD, Wong F, Lygidakis NA. An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. European Archives of Paediatric Dentistry. 2022; 23: 23–38.

[10] Elzein R, Chouery E, Abdel-Sater F, Bacho R, Ayoub F. Molar incisor hypomineralisation in Lebanon: prevalence and clinical characteristics. European Archives of Paediatric Dentistry. 2020; 21: 609–616.

[11] Bandeira Lopes L, Machado V, Botelho J, Haubek D. Molar-incisor hypomineralization: an umbrella review. Acta Odontologica Scandinavica. 2021; 79: 359–369.

[12] Reis PPG, Jorge RC, Americano GCA, Thiago Pontes NS, Peres AMAM, Silva Oliveira AGE, et al. Prevalence and severity of molar incisor hypomineralization in Brazilian children. Pediatric Dentistry. 2021; 43: 270–275.

[13] Goel N, Jha S, Bhol S, Dash BP, Sarangal H, Namdev R. Molar incisor hypomineralization: clinical characteristics with special emphasis on etiological criteria. Journal of Pharmacy and Bioallied Sciences. 2021; 13: S651–S655.

[14] Bekes K, Mitulović G, Meißner N, Resch U, Gruber R. Saliva proteomic patterns in patients with molar incisor hypomineralization. Scientific Reports. 2020; 10: 7560.

[15] Velásquez N, Pérez-Ybarra L, Urdaneta CJ, Pérez-Domínguez M. Sialometry and concentration of phosphate and calcium in stimulated whole saliva and gingival crevicular fluid and its association with dental caries in schoolchildren. Biomédica. 2019; 39: 157–169.

[16] Inonu E, Hakki SS, Kayis SA, Nielsen FH. The association between some macro and trace elements in saliva and periodontal status. Biological Trace Element Research. 2020; 197: 35–42.

[17] Krikheli NI, Karamysheva EI, Lukina GI, Dubova LV. Mineral composition of mixed saliva in patients with dental fluorosis. Stomatologiya. 2017; 96: 26–29. (In Russian)

[18] Shirzaiy M, Heidari F, Dalirsani Z, Dehghan J. Estimation of salivary sodium, potassium, calcium, phosphorus and urea in type II diabetic patients. Diabetes & Metabolic Syndrome. 2015; 9: 332–336.

[19] Küchler EC, Pecharki GD, Castro ML, Ramos J, Barbosa Jr F, Brancher JA, et al. Genes involved in the enamel development are associated with calcium and phosphorus level in Saliva. Caries Research. 2017; 51: 225–230.

[20] da Silva FMF, de Carvalho FM, Franco ALMM, Soares TRC, Fonseca-Gonçalves A, Vieira AR, et al. Association between molar hypomineralization, genes involved in enamel development, and medication in early childhood: a preliminary study. To be published in International Journal of Paediatric Dentistry. 2023. [Preprint].

[21] Braga MM, Oliveira LB, Bonini GAVC, Bönecker M, Mendes FM. Feasibility of the international caries detection and assessment system (ICDAS-II) in epidemiological surveys and comparability with standard world health organization criteria. Caries Research. 2009; 43: 245–249.

[22] World Health Organization. Oral health surveys: basic methods. 4th edn. World Health Organization: Geneva. 1997.

[23] Greene JG, Vermillion JR. The simplified oral hygiene index. The Journal of the American Dental Association. 1964; 68: 7–13.

[24] Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker L. A modified gingival index for use in clinical trials. Clinical Preventive Dentistry. 1986; 8: 3–6.

[25] Sidhu N, Wang Y, Barrett E, Casas M. Prevalence and presentation patterns of enamel hypomineralisation (MIH and HSPM) among paediatric hospital dental patients in Toronto, Canada: a cross-sectional study. European Archives of Paediatric Dentistry. 2020; 21: 263–270.

[26] Deldago RM, Botelho J, Machado V, Mendes JJ, Lopes LB. Knowledge, perception, and clinical experiences on molar incisor hypomineralization amongst Portuguese dentist. BMC Oral Health. 2022; 22: 250.

[27] Kotsanos N, Kaklamanos E, Arapostathis K. Treatment management of first permanent molars in children with molar-incisor hypomineralisation. European Journal of Paediatric Dentistry. 2005; 6: 179–184.

[28] Mejàre I, Bergman E, Grindefjord M. Hypomineralized molars and incisors of unknown origin: treatment outcome at age 18 years. International Journal of Paediatric Dentistry. 2005; 15: 20–28.

[29] Estivals J, Fahd C, Baillet J, Rouas P, Manton DJ, Garot E. The prevalence and characteristics of and the association between MIH and HSPM in South-Western France. International Journal of Paediatric Dentistry. 2023; 33: 298–304.

[30] McCarra C, Olegário IC, O’Connell AC, Leith R. Prevalence of hypomineralised second primary molars (HSPM): a systematic review and meta-analysis. International Journal of Paediatric Dentistry. 2022; 32: 367–382.

[31] Stoica S, Nimigean V, Moraru SA, Sîrbu I, Nimigean VR. A clinical and statistical study on enamel hypomineralization of the first permanent molar in the period of mixed dentition. Romanian Journal of Morphology and Embryology. 2023; 64: 241–249.

[32] Harz D, Catalán Gamonal B, Matute García S, Jeremias F, Martin J, Fresno MC. Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren. European Archives of Paediatric Dentistry. 2023; 24: 577–584.

[33] Ajzman GB, Dagon N, Iraqi R, Bulumer A, Fadela S. The Prevalence of developmental enamel defects in Israeli children and its association with perinatal conditions: a cross-sectional study. Children. 2023; 10: 903.

[34] Alzahrani AY, Alamoudi NMH, El Meligy OAS. Contemporary understanding of the etiology and management of molar incisor hypomineralization: a literature review. Dentistry Journal. 2023; 11: 157.

[35] Fagrell TG, Ludvigsson J, Ullbro C, Lundin SA, Koch G. Aetiology of severe demarcated enamel opacities—an evaluation based on prospective medical and social data from 17,000 children. Swedish Dental Journal. 2011; 35: 57–67.

[36] Pitiphat W, Luangchaichaweng S, Pungchanchaikul P, Angwaravong O, Chansamak N. Factors associated with molar incisor hypomineralization in Thai children. European Journal of Oral Sciences. 2014; 122: 265–270.

[37] Sönmez H, Yıldırım G, Bezgin T. Putative factors associated with molar incisor hypomineralisation: an epidemiological study. European Archives of Paediatric Dentistry. 2013; 14: 375–380.

[38] Durmus B, Abbasoglu Z, Peker S, Kargul B. Possible medical aetiological factors and characteristics of molar incisor hypomineralisation in a group of Turkish children. Acta Stomatologica Croatica. 2013; 47: 297–305.

[39] Børsting T, Schuller A, van Dommelen P, Stafne SN, Skeie MS, Skaare AB, et al. Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7–9 years of age: a longitudinal study. European Archives of Paediatric Dentistry. 2022; 23: 557–566.

[40] Alaluusua S. Aetiology of molar-incisor hypomineralisation: a systematic review. European Archives of Paediatric Dentistry. 2010; 11: 53–58.

[41] Shah VU, Dave BH, Chari DN, Shah KA. Prevalence, severity and associated risk indicators of molar incisor hypomineralization amongst 8–13-year-old children of Vadodara District Gujarat: a cross-sectional study. International Journal of Clinical Pediatric Dentistry. 2023; 16: 280–286.

[42] Shinde MR, Winnier JJ. Correlation between aerosol therapy and other associated factors in early childhood with molar incisor hypomineralization. International Journal of Clinical Pediatric Dentistry. 2022; 15: 554–557.

[43] Haque Afzal S, Wigen TI, Skaare AB, Brusevold IJ. Molar-incisor hypomineralisation in Norwegian children: prevalence and associated factors. European Journal of Oral Sciences. 2023; 131: e12930.

[44] Linner T, Khazaei Y, Bücher K, Pfisterer J, Hickel R, Kühnisch J. Hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH). Scientific Reports. 2021; 11: 17922.

[45] Raposo F, de Carvalho Rodrigues AC, Lia ÉN, Leal SC. Prevalence of hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH). Caries Research. 2019; 53: 424–430.

[46] Bonzanini LIL, Arduim ADS, Lenzi TL, Hugo FN, Hilgert JB, Casagrande L. Molar-incisor hypomineralization and dental caries: a hierarchical approach in a populational-based study. Brazilian Dental Journal. 2021; 32: 74–82.

[47] Farias L, Laureano ICC, Fernandes LHF, Forte FDS, Vargas-Ferreira F, Alencar CRB, et al. Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren. Brazilian Oral Research. 2021; 35: e13.

[48] Mazur M, Corridore D, Ndokaj A, Ardan R, Vozza I, Babajko S, et al. MIH and dental caries in children: a systematic review and meta-analysis. Healthcare. 2023; 11: 1795.

[49] Negre-Barber A, Montiel-Company J, Catalá-Pizarro M, Almerich-Silla J. Degree of severity of molar incisor hypomineralization and its relation to dental caries. Scientific Reports. 2018; 8: 1–7.

[50] Ghanim A, Marino R, Morgan M, Bailey D, Manton D. An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren. International Journal of Paediatric Dentistry. 2013; 23: 2–12.

[51] Schraverus M, Olegário I, Bonifácio C, González A, Pedroza M, Hesse D. Glass ionomer sealants can prevent dental caries but cannot prevent posteruptive breakdown on molars affected by molar incisor hypomineralization: one-year results of a randomized clinical trial. Caries Research. 2021; 55: 301–309.

[52] Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assunção LR, et al. Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clinical Oral Investigations. 2021; 25: 1513–1524.

[53] Gevert MV, Soares R, Wambier LM, Ribeiro AE, Avais LS, de Souza JF, et al. How is the quality of the available evidence on molar-incisor hypomineralization treatment? An overview of systematic reviews. Clinical Oral Investigations. 2022; 26: 5989–6002.

[54] Farah RA, Drummond BK, Swain MV, Williams S. Relationship between laser fluorescence and enamel hypomineralisation. Journal of Dentistry. 2008; 36: 915–921.

[55] Fütterer J, Ebel M, Bekes K, Klode C, Hirsch C. Influence of customized therapy for molar incisor hypomineralization on children’s oral hygiene and quality of life. Clinical and Experimental Dental Research. 2020; 6: 33–43.

[56] Praptiwi YH, Prayitno ND, Sukmasari S. Prevalence of molar incisors hypomineralisation (MIH) in primary school children. Padjadjaran Journal of Dentistry. 2019; 31: 79–84.

[57] Ulusoy AT, Sen Tunc E, Bayrak Ş, Onder H. A comparative study of oral health parameters in molar incisor hypomineralization and high-caries-risk children aged 8-11 years. Medical Principles and Practice. 2016; 25: 85–89.

[58] Jälevik B, Odelius H, Dietz W, Norén J. Secondary ion mass spectrometry and X-ray microanalysis of hypomineralized enamel in human permanent first molars. Archives of Oral Biology. 2001; 46: 239–247.

[59] Bozal CB, Kaplan A, Ortolani A, Cortese SG, Biondi AM. Ultrastructure of the surface of dental enamel with molar incisor hypomineralization (MIH) with and without acid etching. Acta Odontológica Latinoamericana. 2015; 28: 192–198.

[60] Fagrell TG, Dietz W, Jälevik B, Norén JG. Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars. Acta Odontologica Scandinavica. 2010; 68: 215–222.

[61] Crombie FA, Cochrane NJ, Manton DJ, Palamara JEA, Reynolds EC. Mineralisation of developmentally hypomineralised human enamel in vitro. Caries Research. 2013; 47: 259–263.

[62] Taube F, Marczewski M, Norén JG. Deviations of inorganic and organic carbon content in hypomineralised enamel. Journal of Dentistry. 2015; 43: 269–278.

[63] Martinovic B, Ivanovic M, Milojkovic Z, Mladenovic R. Analysis of the mineral composition of hypomineralized first permanent molars. Vojnosanitetski Pregled. 2015; 72: 864–869.

[64] Alifakioti E, Arhakis A, Oikonomidis S, Kotsanos N. Structural and chemical enamel characteristics of hypomineralised second primary molars. European Archives of Paediatric Dentistry. 2021; 22: 361–366.

[65] Mangum JE, Crombie FA, Kilpatrick N, Manton DJ, Hubbard MJ. Surface integrity governs the proteome of hypomineralized enamel. Journal of Dental Research. 2010; 89: 1160–1165.

[66] Farah RA, Monk BC, Swain MV, Drummond BK. Protein content of molar-incisor hypomineralisation enamel. Journal of Dentistry. 2010; 38: 591–596.

[67] Velásquez N, Pérez-Ybarra L, Urdaneta CJ, Pérez-Domínguez M. Sialometry and concentration of phosphate and calcium in stimulated whole saliva and gingival crevicular fluid and its association with dental caries in schoolchildren. Biomedica. 2019; 39: 157–169.

[68] Rovera A, Rovera G, Alzahrani A, Hector M, Anderson P. Correlation between parotid saliva composition and dental caries using 31P-NMR and ICDAS score. Archives of Oral Biology. 2020; 111: 104651.

[69] Weber ML, Hsin HY, Kalay E, BroŽková DS, Shimizu T, Bayram M, et al. Role of estrogen related receptor beta (ESRRB) in DFN35B hearing impairment and dental decay. BMC Medical Genetics. 2014; 15: 81.

[70] Küchler EC, Gerlach RF, Cunha AS, Ramazzotto LA, Spada PP, Nelson-Filho P, et al. Calcium and phosphorus levels in saliva are influenced by genetic polymorphisms in estrogen receptor alpha and microrna17. Brazilian Dental Journal. 2020; 31: 466–470.