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Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren.

Introduction

Molar incisor hypomineralisation (MIH) resulting from developmental qualitative disturbance of tooth enamel is commonly encountered in clinical practice and presents challenging problems of compromised aesthetics, tooth sensitivity, and caries susceptibility [Weerheijm et al., 2003; Jalevik, 2010; Ghanim et al., 2011a]. This developmental defect of enamel often affects one to four first permanent molars, with or without involvement of the permanent incisors [Weerheijm et al., 2003]. It is the consequence of insults to the highly specialised and vulnerable ameloblast cells, apparently during the later mineralisation phase of amelogenesis resulting in defective enamel with significantly increased protein content [Farah et al., 2010; Mangum et al., 2010]. Clinically, MIH presents with a spectrum of severity ranging from alteration in enamel translucency and varying in degree from creamy-white to yellow-brown demarcated opacities, to deficiencies in enamel substance following tooth eruption (known as post-eruptive enamel breakdown) [Weerheijm et al., 2003].

The prevalence of MIH is variable worldwide but may be increasing [Weerheijm, 2004]. In a broader part of the present study which investigated the prevalence of MIH in the permanent dentition amongst school-aged Iraqi children, 18.6% of the surveyed children were found to be affected with MIH. Creamy white opacities were the most frequent type of defect, and the more severe the lesion the greater was the involved tooth surface area [Ghanim et al., 2011b].

Environmental conditions thought to affect ameloblast function range from ill-health during pregnancy to perinatal medical conditions such as premature birth and low birth weight to early childhood acute illnesses including pneumonia and unexplained high fever [Chawla et al., 2008; Arrow, 2009; Alaluusua, 2010]. Various environmental chemicals, including dioxin, bisphenol A and drugs such as asthma medications and amoxicillin have also been identified as contributing to or causing MIH [Alaluusua et al., 1996; Whatling and Fearne, 2008; Wogelius et al., 2010]. Whilst the role of fluoride in preventing dental caries is well recognised, its role in the aetiology of demarcated hypomineralisation lesions is perplexing. Some authors suggested that intracellular changes in fluoride ion concentration could alter the threshold of the ameloblast to form defective enamel; however this suggestion has not been confirmed [Balmer et al., 2005]. However the same authors reported that fluoride has a protective effect against the development of demarcated lesions [Balmer et al., 2011].

Optimal dental health can be obtained when appropriate oral hygiene practices and dental behaviours are maintained in conjunction with a low cariogenic diet in the presence of adequate saliva. Individual oral health care mainly involves daily oral hygiene practices, including tooth brushing and flossing, and regular cleaning and care at the dental office [Abegg et al., 2000; Attin and Hornecker, 2005]. When a tooth has a defect it is often difficult to clean it. Poor daily oral care could not just worsen the clinical status of a defective tooth, but could also have a negative impact on the remaining sound tooth structure leading to increased treatment needs. It is recognised that MIH predisposes an affected tooth surface to plaque accumulation, sensitivity, and may contribute to dental caries development [da Costa-Silva et al., 2010; Lygidakis et al., 2010]. Information about the impact of MIH on the oral health care of the affected individuals is, however, lacking.

The aims of the present study were to describe and compare individual oral health care practices between MIH-affected and non-affected children. To evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars. To explore the role of reported fluoride exposure in the development of MIH.

Materials and methods

Population sample. The data used in this study were collected between October 2009 to June 2010, as part of a larger cross-sectional study investigating MIH-prevalence, severity and aetiological factors in 7-9 year-old primary school children in Mosul City, Iraq. Ethical approvals from the Human Research Ethics Committee of the University of Melbourne and the Dental College of Mosul University were obtained. Permission was obtained from the Education Department of the Nineveh Governorate and from schools' directors. A total of 823 of 1,000 subjects had parents/guardians given informed consent and participated in the study (response rate 82.3%) [Ghanim et al., 2011b]. The study included a clinical examination for the children, a systemic health questionnaire-based interview and a self-answered structured questionnaire for each child's mother that will be explained later. The natural concentration of fluoride in the reticulated water supply of the community has been recorded as below 0.19 [+ or ] 0.07 ppm F [Al-Dahan and Al-Rawi, 2006].

Survey instrument. Based on an Australian study [Chawla et al., 2008]; a self-answered structured questionnaire was developed to compare the oral health activities of MIH-affected subjects with the non-affected counterparts. Sixteen questions were developed regarding history of dental visits, fluoride intake and the pattern of oral hygiene practices from early childhood (i.e. one year-old) up to the time this study was conducted. The questions were validated in terms of applicability and repeatability prior to the study. Assessment of the relevant oral health components (via multiple choice questions) included the following:

* Biographic variables: child's age of first dental visit; reason/s for first dental visit; frequency of seeking dental care.

* Fluoride exposure variables: systemic exposure to fluoride (i.e. community water fluoridation); use of topical fluoride other than toothpaste such as chewed tablets, gel application, mouth rinse (professional and/or personal application); age started using toothpaste; type of fluoridated toothpaste; amount of applied toothpaste; toothpaste swallowing tendency.

* Oral hygiene practice variables: age at which parents started brushing their child's teeth, age at which child's started brushing his/her own teeth; frequency of brushing when first started, and at present; brushing supervision.

A questionnaire was constructed in English, translated into Arabic, and back-translated into English to confirm content. Each mother was asked to complete the questionnaire administered at the school in the presence of the principal investigator (AG). On completing the questionnaire clinical examinations were performed by AG with the aid of an assistant to record the observations on data sheets provided for that purpose. The sampling included similar numbers in each age and gender group. Participating children were given a toothbrush and fluoridated toothpaste to brush their teeth thoroughly. First permanent molars and incisor teeth were examined for the presence of MIH [Ghanim et al., 2011b]. The EAPD evaluation criteria were used to identify MIH-characteristic hypomineralisation including demarcated opacities, post-eruptive enamel loss, atypical restorations and missing tooth presumably due to demarcated lesions [Weerheijm et al., 2003]. The grade of hypomineralisation for each individual tooth was classified by the most severe defect observed on its surface. The clinical examination also included a full mouth caries assessment following the International Caries Detection and Assessment System for a sub group of children [ICDAS II, 2005; Ghanim et al., 2012].

A number of clinical measures to assess dental treatment needs were included: a) teeth that had apparently sound restorations or diagnosed as caries-free were categorised under "no dental treatment required/require primary prevention", b) teeth diagnosed with caries lesions in enamel and/ or dentine, teeth with a broken restoration or restoration with secondary caries at the margins were categorised under "require restoration", c) extracted and badly broken down teeth that could not be restored were categorised under "require extraction and/or space closure".

Data analysis. In order to compare variables distribution the sample was dichotomised into two categories: those diagnosed with MIH (referred to as 'MIH-affected group'; n=153) and those who were non-MIH-affected (control; n=670). Previous analysis also reported about 72% of the total affected group were diagnosed with demarcated opacities, distributed as (39.8% with creamy white opacities and 32% with yellow brown opacities), post-eruptive enamel breakdown, atypical restoration and tooth missing due to MIH were found in 28% [Ghanim et al., 2011b]. Binary logistic regression analysis was performed to determine differences between the study groups by oral hygiene practices, dental visits and to assess whether exposure to fluoride has a role in MIH occurrence. Three models were fitted with three different sets of explanatory variables. These were biographic variables (grouped into four categories), fluoride exposure variables (grouped into three categories) and oral hygiene practice variables (grouped into eight categories). All explanatory variables in the set were used in the model (so-called "enter method") and reported on each of the three full models. In the individual model, each variable was considered as a potential confounder and the data was analysed with and without controlling for the potential confounder. To compare dental treatment requirements for first permanent molars, from the total group of MIH-affected children, a sample subset was drawn (n=100) who had their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System [ICDAS II 2005, Ghanim et al., 2012]. This sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. Chi-square ([chi square]) statistics were used for testing the relationship between MIH severity and tooth brushing frequency and for assessing differences in the treatment required between hypomineralised and non-hypomineralised first molars. Differences at an alpha level < 0.05 were considered statistically significant. Data were coded and entered into SPSS (ver. 18.0; SPSS Inc, Chicago, IL, USA).

Results

Population sample distribution by biographic variables. The distributions and differences between the study groups by history of dental visits and fluoride exposure variables are presented in Table 1. In both groups, the majority of parents (70.8%) indicated that they had taken their children to the dentist at some time. When the two groups were compared, the MIH-affected group reported a higher frequency of attendance compared with their non-affected peers (82.4% vs 68.2%, respectively) ([chi square](1) = 12.1, p<0.001). The most likely causes for seeking dental care at the first dental appointment was "other reasons such as tooth filling or extraction" (57.9%) for both groups. When mothers were asked about the frequency of visiting a dentist, "once every three months" was the most reported response for the MIH-affected group (72.8%), whereas "once a year" was the most common response among the non-affected group (55.8%).

Logistic regression analysis was performed to compare study groups by biographic variables. The test of the model with its four predictors was statistically significant ([chi square](7) = 127.7, p<0.001), indicating that the predictors, as a set, reliably distinguished between MIH-affected and non-affected subjects. Nagelkerke's R2, an indicator of the goodness-of-fit of the model, was 30.6%. After controlling for the other independent variables included in the model, children displaying the defect were over three times more likely to visit the dentist complaining of pain and were over six times more likely to seek dental care due to tooth sensitivity than were their non-affected counterparts (OR = 3.18, 95% CI 1.27-7.95; OR = 6.37, 95% CI 1.64-24.71; respectively).

Population sample distribution by fluoride exposure variables. The distributions and differences between the study groups by fluoride exposure variable are presented in Table 1. Tap water was the main source of water consumed at home by the majority of children (77.8%). Early consumption of fluoridated water and exposure to different sources of topical fluoride was noted by only a minority of respondents (18.9%, 21.2%; respectively) and therefore was not statistically evaluated. Modeling of variables for type of water consumed at home and for a positive history of exposure to fluoridated water revealed a statistical significant relationship with MIH occurrence, ([chi square] (2) = 10.1, p<0.01). After controlling for other variables present in the model, exposure to fluoridated water up to the age of three years appeared to have a protective effect for MIH (OR = 0.38; 95% CI 0.20-0.73). Nagelkerke's [R.sup.2], an indicator of the goodness-of-fit of the model, was 2%.

Population sample distribution by oral hygiene practice variables. The distribution and difference between the study groups when compared by tooth brushing and toothpaste history are presented in Table 2. Most parents in both study groups commenced brushing their child's teeth after three years of age (63.9%). Most children had commenced brushing on their own between 4-6 years of age (59.9%). Brushing supervision "on occasion" was the most frequently chosen option (48%). The initial daily frequency of tooth brushing as well as when the children were older was at least once-a-day (76.2%, 58.7%, respectively). A pea-sized amount of toothpaste was claimed to be used by 29% of the children, and children's toothpaste was most commonly used by both groups (30.3%). To test differences between study groups regarding brushing and toothpaste history, a logistic regression model was used. The test for this model with its eight predictors did not reach statistical significance ([chi square] (32) = 12.4, p>0.05).

Defect clinical presentation and daily tooth brushing frequency. The distribution of the affected subjects in terms of lesion severity and brushing frequency per day is presented in Table 3. Analysis of the possible relationship between MIH severity and brushing frequency did not reach statistical significance. However, the frequency of brushing decreased remarkably with the increase in lesion severity. Non-brushing was approximately twice as common in children with post-eruptive enamel breakdown/ atypical restoration than in children with creamy white opacities.

Tooth sample distribution by dental caries status and dental treatment required. The distribution of dental caries experience and dental treatment required in a sample subset of hypomineralised and non-hypomineralised molars is presented in Table 4. Non-hypomineralised molars were over three times more caries-free than the hypomineralised ones (66.3% vs. 20.0%, respectively). The prevalence of dental caries and tooth restorations was higher in hypomineralised molars (78.5%) than in the defect-free molars (33.7%). No broken restorations (normal or atypical) or secondary caries were observed. The two molars missing in the sample had been extracted due to demarcated lesions. A significant difference existed between hypomineralised and non-hypomineralised molars when assessing their dental caries status ([chi square] (2) = 77.28, p<0.001). With regard to required dental treatment, 21.5% of the hypomineralised molars did not require treatment compared with 74% of the non-hypomineralised molars. Over half of the affected molars required restorative intervention compared withh 23.7% of the defect-free molars. Extraction and orthodontic intervention was deemed necessary for 16.2% of the hypomineralised molars compared with only 2.2% for their non-affected counterparts. Assessment of the total dental treatment required revealed a highly significant difference between hypomineralised and non-hypomineralised molars ([chi square] (2) = 99.84, p<0.001).

Discussion

The present study derived its sample from public primary schools and therefore included children from different socioeconomic backgrounds. The high rate of primary school attendance at various socio-economic levels of students in public schools in Iraq [Iraq Education Sector Scoping Study, 2009] supports the representativeness of the sample for the Iraqi children in this age group. All parents appeared to be dentally aware, commenced cleaning their children's teeth in early childhood, occasionally assisting or supervising tooth brushing with age-appropriate strength fluoride toothpastes delivered in appropriate amounts. Although it appears that MIH lesions have no role on brushing frequency as tooth cleaning "once-a-day" was the most common self-reported practice in both study groups and the relationship between the defect severity and brushing frequency in the affected children was not statistically significant, lesion severity appears to play a role. There was a considerable reduction in the cleaning frequency with increased lesion severity supporting the evidence from past literature on tooth pain and sensitivity as detrimental outcomes of severe lesions [Weerheijm et al., 2001; Kotsanos et al., 2005]. In the non-MIH subjects, the yearly dental visits could be attributed to the absence of clinical complaint in those children particularly when compared with their affected counterparts who sought dental consultation every three months. The increased treatment need amongst the affected children confirmed the burden caused by this defect for both children and their parents, and is in agreement with previous findings [Jalevik and Klingberg, 2002; Chawla et al., 2008].

In a conjoint study comparing dental caries status between MIH-affected and non-affected children, the mean caries index scores (DMFT) in the affected subjects was double that of their counterparts [Ghanim et al., 2012]. In the present results, the deteriorating dental health status and increased treatment demands for those subjects with hypomineralised teeth support previous study findings and confirmed that demarcated hypomineralised defect is a prominent caries risk factor [Elfrink et al., 2010; Nelson et al., 2010]. In previous research studies, dental caries status was compared between affected and non-affected study groups [Leppaniemi et al., 2001; Muratbegovic et al., 2007; da Costa-Silva et al., 2010], and information on the dental treatment performed rather than treatment required was reported [Jalevik and Klingberg, 2002; Chawla et al., 2008]. In study, dental treatment was assessed prospectively and non-affected teeth selected from subjects diagnosed with demarcated lesions to control for possible confounding factors, such as individual dietary habits and salivary characteristics, and to highlight the effect of MIH as the key factor in deteriorating tooth health status. With the weakened physical properties of hypomineralised enamel, lesions will rapidly progress if high caries challenge is superimposed, resulting in greater ongoing need for dental care.

The lack of exposure to fluoride, whether systemically or as supplementation, would suggest it was unlikely that the mild hypomineralisation defects, distinctive MIH-clinical presentations diagnosed in the study group, were fluorotic lesions. However, the findings of exposure to topical fluoride should be considered with caution as the response rate to this question in both groups was relatively low (40.6%). On the other hand, exposure to fluoridated water during early childhood was reported by a minority of the sample of whom the majority was represented by non-affected children. Therefore, consistent with a recent study [Whatling and Fearne, 2008], it is highly unlikely that fluoride is a potential causative factor of MIH. Surprisingly, the analyses showed that exposure to fluoride up to the first three years of life seemed to be protective against MIH, in agreement with a recent UK study [Balmer et al., 2011]. This supports the notion that early exposure to fluoride could increase the resistance of enamel to defect development [Cutress et al., 1985; Balmer et al., 2005]. However, the result should be treated with caution as it is based on self-reported information and the concentration of the fluoride in the bottled water was unknown. In addition, only a few MIH-cases reported early fluoride exposure and the percentage of the variance accounted for by early exposure to fluoride in the full model was remarkably low.

Clinical data collected in the present study showed that a higher proportion of unmet restorative need was most frequently observed in the MIH-affected group. Follow-up and recall programs are essential to ensure that unmet needs are addressed. For example, a screening program by trained oral health personnel could be established which allows for early detection, treatment and opportunities for referral.

It was noted that the predictive power of the multiple regression models was not large (between 2% and 30% of the variance), indicating a need for future research in this area to identify additional predictors. Given differences in the predictive power of clinical and subjective indicators, future dental health care assessment can be better achieved by conducting longitudinal prospective studies. These studies should include both professionally determined clinical parameters as well as subjective indicators, such as accurate indicators of caries risk and dental health knowledge. Improved prediction could increase the capacity of dental health services to respond to oral health treatment needs in young populations diagnosed with MIH.

The present results need to be considered within the limitations of the study design. The questions in the survey were designed to be as simple and clear as possible, however, some questions reported low response rates which could be in part attributed to recall difficulties or trouble understanding the question. The most obvious shortcoming is the potential for recall bias in asking the mother to self-report retrospectively on her child's dental health history. In addition several variables were not investigated comprehensively. For example the frequency of mouth rinsing after meals, the quality of brushing and flossing practices were not determined, and the findings are restricted to a sub-group of the Iraqi community. Nonetheless, for this and other communities, the results can serve as an impetus for further emphasis of the importance of early intervention to prevent or ameliorate progression of defects and reduce the dental treatment need. From a public health perspective, the present study provides the necessary evidence for future introduction of promotion oral health programs under Iraqi conditions.

Conclusions

This is the first study to assess oral care patterns in relation to demarcated hypomineralisation lesions. MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts. They were over three times more likely to visit the dentist due to complaining of tooth sensitivity and pain than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" commonly reported in both groups. Hypomineralised molars required more the twice the amount of restorative care than unaffected molars.

Acknowledgments

We are grateful to all the children and their mothers for participating in the study and the school principals for their cooperation in performing this study. Special thanks to Professor Alsandook and Dr Alnuaimi for their support and assistance when collecting data. We should like to acknowledge Dr Chawla and her co-authors' contribution of the oral health questionnaire used in the Australian study. The support of the Oral Health CRC, the University of Melbourne and the Education Department of the Nineveh Governorate is acknowledged with gratitude.

References

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A.M. Ghanim, D.J. Manton, M.V. Morgan, R.J. Marino, D.L. Bailey. Oral Health CRC, Melbourne Dental School, The University of Melbourne, Parkville Victoria, Australia.

Postal address: Dr A. Ghanim, Population Oral Health & Periodontics, Melbourne Dental School, The University of Melbourne, Victoria, 3010 Australia.

Email: dentagh@gmail.com
Table 1. Frequency distribution of MIH-affected and non-affected
Iraqi children by dental visits and fluoride exposure variables *

                                      MIH-affected    Non-MIH affected
Biographic factors                    (N=153) N (%)    (N=670) N (%)

Child's visit to the dentist
Yes                                    126 (82.4)        457 (68.2)
No                                      27 (17.6)        213 (31.8)
Total                                      153              670

Age (years) at first dental visit
1-3                                     36 (28.6)        116 (25.3)
4-6                                     66 (52.4)        239 (52.1)
7-9                                     24 (19.0)        104 (22.7)
Total                                      126              459

Reason for first dental appointment
For a check-up                           8 (6.5)         46 (10.0)
Child's teeth "didn't look right"        6 (4.8)         46 (10.0)
** Child complained of pain             42 (33.9)        78 (17.0)
  (sudden, sharp or shooting ache).
*** Child complained of sensitivity     10 (8.1)          9 (2.0)
Other (e.g. tooth restoration,          58 (46.8)        279 (60.9)
  extraction)
Total                                      124              458

Frequency of dental visits at present
Once every 3 months                     91 (72.8)        149 (32.5)
Once every 6 months                     13 (10.4)         34 (7.4)
Once a year                             11 (8.8)         256 (55.8)
Other (e.g. when there is a             10 (8.0)          20 (4.4)
  problem)
Total                                      125              459

Type of water consumed at home at present
Tap water (non-fluoridated)            119 (77.8)        520 (77.8)
Bottled water (fluoridated)             34 (22.2)        148 (22.2)
Total                                      153              668

Use of fluoridated water up to age 3 years
No                                     142 (92.8)        554 (83.3)
([dagger]) Yes                          11 (7.2)         111 (16.7)
Total                                      153              665

Use of topical fluoride other than toothpaste up to age 3 years
No                                      37 (82.2)        226 (78.2)
Yes                                     8 (17.8)         63 (21.8)
Total                                      45               289

* Numbers of the groups may not add to their totals due to missing
values.

** A significant predictor distinguishing between MIH-affected and
non-affected subjects at p=0.007, (from the logistic regression
model).

*** A significant predictor distinguishing between MIH-affected and
non-affected subjects at p=0.013, (from the logistic regression
model).

([dagger]) A significant protective effect at p=0.004, (from the
logistic regression model). MIH: Molar-incisor hypomineralisation.

Table 2. Frequency distribution of MIH-affected and non-affected
Iraqi children by tooth brushing and toothpaste history *

Tooth brushing and                    MIH-affected    Non-MIH affected
toothpaste history                    (N=153) N (%)    (N=670) N (%)

Age (years) when parent started
brush child's teeth
0-1                                      3 (2.0)          8 (1.2)
1-2                                     12 (7.8)          43 (6.4)
2-3                                     39 (25.5)        147 (22.0)
>3                                      82 (53.6)        443 (66.3)
I did not brush my child's teeth        17 (11.1)         27 (4.0)
Total                                      153              668

Age (years) when child started
to brush own teeth
Child still too young                    9 (5.9)          37 (5.5)
< 3                                     12 (7.8)          52 (7.8)
3-4                                     24 (15.7)         50 (7.4)
4-6                                     62 (40.5)        430 (64.3)
> 6                                     46 (30.0)        100 (14.9)
Total                                      153              669

Parent supervises tooth brushing
at present
Yes                                     35 (22.9)        168 (25.3)
Sometimes                               70 (45.8)        322 (48.6)
No                                      48 (31.4)        173 (26.1)
Total                                      153              663

Frequency of brushing per day
when first started
Not at all                              13 (8.7)          20 (3.0)
Once                                   108 (72.0)        514 (77.1)
Twice                                   23 (15.3)        107 (16.1)
More than twice                          6 (4.0)          25 (3.8)
Total                                      150              666

Frequency of brushing per day
at present
Not at all                              40 (26.1)        97 (14.5)
Once                                    58 (37.9)        423 (63.4)
Twice                                   47 (30.7)        125 (18.7)
More than twice                          8 (5.2)          22 (3.3)
Total                                      153              667

Fluoridated toothpaste used
when first started brushing
Yes, from the beginning                115 (76.2)        516 (77.4)
No, only started after the age of:
2-4 years                                9 (6.0)          26 (3.9)
5-8 years                               27 (17.9)        112 (16.8)
Total                                      151              654

Amount of fluoridated toothpaste
used when first started
I did not use toothpaste                11 (7.2)          36 (5.4)
A smear along the brush                 39 (25.5)        182 (27.2)
Pea-size                                48 (31.4)        190 (28.4)
Covering half of the brush              38 (24.8)        182 (27.2)
Covering the whole brush                17 (11.1)        79 (11.8)
Total                                      153              669

Brand of fluoridated toothpaste
usually used
Biofresh Children's toothpaste          17 (11.3)        68 (10.2)
Dentakleen Children's toothpaste        20 (13.2)        89 (13.3)
Other children's toothpaste             46 (30.5)        202 (30.2)
Other adult's toothpaste                33 (21.9)        144 (21.6)
Not sure                                35 (23.2)        165 (24.7)
Total                                      151              668

* Numbers of the groups may not add to their totals due
to missing values. MIH: Molar-incisor hypomineralisation.

Table 3. Distribution of MIH-affected Iraqi children
by defect type and daily tooth brushing frequency

                                          Brushing frequency

                              Twice       Once       Not at
Defect type                   N (%)       N (%)     all N (%)   Total N

White/creamy demarcated     21 (38.2)   30 (51.7)   10 (25.0)     61
  opacities
Yellow/brown demarcated     20 (36.4)   16 (27.6)   13 (32.5)     49
  opacities
Post-eruptive breakdown/    14 (25.5)   12 (20.7)   17 (42.5)     43
  Atypical restoration
Total                          55          58          40         153

MIH: Molar-incisor hypomineralisation

Table 4. Dental caries status and dental treatment required of
hypomineralised and non-hypomineralised first permanent molar in
a group of Iraqi children (n=100)

                                  Hypomineralised  Non-hypomineralised
                                   first molar *     first molar **
                                       N (%)              N (%)
Dental caries status ***
Sound                                26 (20.0)         179 (66.3)
Decayed or restored                 102 (78.5)          91(33.7)
Extracted                             2 (1.5)               0

Dental treatment need ([dagger])
No treatment/Prevention              28 (21.5)         200 (74.1)
Restoration                          81 (62.3)          63(23.7)
Extraction and space closure         21(16.2)            6 (2.2)

* Hypomineralised first molar (n=130). ** Non-hypomineralised
first molar (n=270). *** Significant difference between
hypomineralised and non-hypomineralised molars in caries
experience (x2(2)=77.28, p<0.001). fSignificant difference
between hypomineralised and non-hypomineralised molars in dental
treatment need (x2(2)=103.79, p<0.001).
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Article Details
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Author:Ghanim, A.M.; Manton, D.J.; Morgan, M.V.; Marino, R.J.; Bailey, D.L.
Publication:European Archives of Paediatric Dentistry
Article Type:Report
Geographic Code:7IRAQ
Date:Aug 1, 2012
Words:5476
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