Knowledge of Egyptian Dental Practitioners Regarding Molar-Incisor Hypomineralization
Condition: Molar Incisor Hypomineralization; Dental Enamel Hypoplasia
MeSH terms: Molar Hypomineralization; Dental Enamel Hypoplasia
Study type: Observational

Summary: 
      Molar incisor hypomineralization (MIH) is one of the developmental enamel defect which is
      characterized by demarcated, qualitative defects of enamel of systemic origin affecting one
      to four first permanent molars (FPMs) and frequently associated with incisor involvement.
      Similar lesions can be seen in second primary molars and their presence has been reported as
      a predictive factor for developing MIH. Although the exact etiology of MIH is unclear, it is
      likely to be multi-factorial. Possible etiological factors of MIH are systemic conditions as
      pneumonia, upper respiratory tract infections, asthma, otitis media, hypoxia, high fever,
      hypocalcemia and exposure to antibiotics as amoxicillin.

      The prevalence of MIH has been reported from several studies to be between 2.8 and 40.2 %,
      with the mean approximately 15 %. MIH is considered as a common clinical problem by several
      epidemiological studies from many countries.

      Clinical presentation of MIH can include white, creamy and yellow-brown opacities, irregular
      areas of post eruptive breakdown, which can be mistaken diagnosed as hypoplasia or atypical
      caries. The condition is usually associated with a high disease burden, leading to pain,
      infection and tooth loss. Teeth affected by MIH are at high risk of rapid caries development
      and progression, rapid wear and enamel breakdown. Severely affected enamel disintegrates
      under masticatory forces resulting in post-eruptive breakdown (PEB), which is also a
      characteristic feature of MIH-affected teeth. These teeth require treatment, ranging from
      prevention to restorations and extractions, often under general anesthesia. A
      multidisciplinary cooperation among clinicians is often required, particularly for
      extractions of first permanent molars, when orthodontic consequences need to be considered.
      To evaluate the effect of this condition, questionnaires of dentists and dental professionals
      have been carried out in various countries, including those in Europe, Australia and New
      Zealand, Malaysia, Iraq, Iran and Saudi Arabian. These have generally revealed that MIH has
      been frequently encountered in clinical practice, particularly by dental professionals who
      treat children and that there is a need for further training for the condition. To date
      dental clinicians' concerns regarding MIH have not been extensively assessed in Egypt.
    

Detailed description: 
      In 1970, this condition has been first described as a hypomineralization of the permanent
      first molars (PFMs) but was consistently referred to it as non-fluoride hypomineralization.

      In 2000, there were four presentations that described the same types of developmental defects
      of dental enamel affecting the first permanent molars (FPM) at the European Academy of
      Pediatric Dentistry Congress. These reports called the condition hypomineralized first
      permenet molars FPM, idiopathic enamel hypomineralization in FPM, non-fluoride
      hypomineralisation in FPM and cheese molars. This was not a new condition. It had been
      recognized previously but the congress focused on the fact that it has multiple names and
      that this could conceivably lead to confusion.

      In 2001, it has been desirable to use one name that has no reference to any possible
      etiological factor. So the term "molar-incisor hypomineralization" (MIH) was adopted by
      Weerheijm to describe these developmental defects and he gave it a definition as
      "hypomineralization of systemic origin of 1-4 FPM, frequently associated with affected
      incisors".

      In 2003, it was suggested that any examination for MIH should be undertaken on clean wet
      teeth and optimum at the age of 8-years, as at this age all permanent first molars(PFMs) and
      most of the incisors will have erupted. The MIH diagnostic criteria are defined using the
      modified defect of dental enamel (DDE) index, based on criteria by Weerheijm.

      Degree of MIH severity Modified DDE index (FDI 1992) Mild degree:- 30% of enamel surface area
      affected by MIH Moderate degree:- 31 - 49% of enamel surface area affected by MIH Severe
      degree:- 50% of enamel surface area affected by MIH

      Definitions of the criteria used for diagnosing MIH

        -  Opacity:-A defect involving an alteration in the translucency of the enamel. The
           defective enamel is of normal thickness at the time of tooth eruption with a smooth
           surface and white, yellow or brown color. The borders of the lesions are demarcated.

        -  PEB (post eruptive enamel breakdown):- The defect is indicating deficiency of the
           surface after eruption of the tooth. This may be caused by such factors as masticatory
           forces, attrition and trauma (physiological or pathological).

        -  Atypical Restoration (iatrogenic factor):-Size and shape of restoration do not conform
           to typical restorative characteristics. In most cases, restorations will be extensive
           (involving buccal or palatal smooth surface). At the border of the restoration, opacity
           may be noticed.

        -  Extraction due to MIH:- Absence of the first permanent molar in a sound dentition is
           suspected to have been an MIH condition (should take detailed past history, clinical
           examination of other first permanent molars and incisors).

      Many studies have been done to single out a specific etiology for MIH. In 2006, A review by
      William stated that although an etiology is not known at this time, children who had poor
      general health in their first three years of life, who were preterm born (low birth weight
      infants) or were exposed to certain environmental contaminants may be at risk for MIH.

      The majority of prevalence and severity studies of MIH to date have taken place in Europe. In
      2003, Weerheijm and Mejàre attempted to map its occurrence throughout Europe using a
      questionnaire sent to members of the European Academy of Pediatric Dentistry.

      In 2008, Crombie carried out a questionnaire to assess knowledge of members of the Australian
      and New Zealand Society of Pediatric Dentistry and found that MIH was widely recognized.

      In 2011, a survey mainly about prevalence and etiology of MIH was carried out among teaching
      staff across all specialties in one dental college in Iraq by Ghanim.

      In 2014, two surveys were published investigating the knowledge of Iranian and Malaysian
      dentists on the etiology, prevalence and management of MIH by Bagheri, Hussein .

      In 2014, A study conducted in Jeddah, Saudi Arabia found a prevalence of MIH of 8.6 % by
      Allazzam and In 2015, another study about the knowledge of Saudi Arabian dental practitioners
      and students was done by M. J. Silva.

      In 2015, A survey was done to estimate the knowledge of pediatric dentists and general dental
      practitioners in UK.

      In 2016, A study on knowledge of Australian and Chilean public oral health care practitioners
      was done.

      The aim of the study is to assess the knowledge of Egyptian dental practitioners regarding
      the prevalence, etiology, diagnosis and the management of Molar Incisor Hypomineralization
      (MIH)
    

Intervention name(s): self-administered questionnaire
Intervention type(s): Other
Intervention description(s): Self-administered questionnaires with plain language statements and brief description of the clinical features and photographs of MIH were used to determine the knowledge, awareness and perception regarding the prevalence, severity, etiology and treatment modalities of molar-incisor hypomineralization (MIH) among Egyptian fifth year dental students, general dental practitioners and dental specialists.
There were two routes for delivering the questionnaire either as online questionnaire sent to the participants by email or as a hard copy that is hand delivered.
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Fifth year dental students, general dental practitioners and dental specialists.
      
Keywords: Molar incisor hypomineralization; General dental practitioners; Perception; knowledge; Oral health