children
Article
Etiology of Molar-Incisor Hypomineralization (MIH):
A Cross-Sectional Study of Saudi Children
Latifa Alhowaish *, Laila Baidas, Mohammed Aldhubaiban, Lanre L. Bello and Nouf Al-Hammad
Pediatric Dentistry and Orthodontics Department, College of Dentistry, King Saud University,
Riyadh 12372, Saudi Arabia; LBaidas@KSU.EDU.SA (L.B.); maldhubaiban@ksu.edu.sa (M.A.);
LBello@ksu.edu.sa (L.L.B.); nalhammad@ksu.edu.sa (N.A.-H.)
* Correspondence: lalhowaish@ksu.edu.sa
Citation: Alhowaish, L.; Baidas, L.;
Aldhubaiban, M.; Bello, L.L.;
Abstract: (1) Background: Molar-incisor hypomineralization (MIH) is a common clinical condition
with critical negative consequences for dental health. The etiology of MIH is still not completely
understood, although several theories have been suggested. (2) Aim: To investigate the etiology of
MIH defects in a sample of Saudi school children. (3) Method: A total of 893 school children in the
age range of 8–10 years participated in the study. The sample was taken from Riyadh City, Saudi
Arabia. The participating children were examined for MIH using the European Academy of Pediatric
Dentistry Criteria. The children’s parents were asked about the child’s pre, peri-, and postnatal
condition utilizing a structured and validated questionnaire. (4) Results: A total of 362 children
(168 males and 194 females) were affected with MIH, for a prevalence of 40.5%. Among all analyzed
etiological factors, only jaundice was found to be significantly associated with MIH in children
(OR = 1.35, p = 0.047). Multivariate logistic regression analysis confirmed that the only significant
etiological factor for MIH was newborn jaundice (p = 0.04). (5) Conclusion: Newborn jaundice
was the only etiological factor that showed a significant association with MIH in the studied Saudi
school children.
Al-Hammad, N. Etiology of MolarIncisor Hypomineralization (MIH):
A Cross-Sectional Study of Saudi
Keywords: MIH; molar-incisor hypomineralization; children; enamel; etiology; pediatric dentistry;
dental anomalies
Children. Children 2021, 8, 466.
https://doi.org/10.3390/
children8060466
1. Introduction
Academic Editor: Diana Ram
Received: 15 May 2021
Accepted: 30 May 2021
Published: 2 June 2021
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Copyright: © 2021 by the authors.
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Attribution (CC BY) license (https://
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4.0/).
In 2001, Weerheijm and his colleagues were the first to describe a developmental
enamel defect, and name it molar-incisor hypomineralization (MIH) [1]. This defect is of
qualitative nature, and presents as reduced mineralization and increased porosity of the
enamel structure. It can affect at least one and up to four first permanent molars, with
or without the involvement of the permanent incisors [1]. Enamel defects in MIH range
from demarcated opacities with white or yellow/brown discoloration to a severe form of
MIH that is characterized by post-eruptive enamel breakdown due to the combination of
occlusal load, and an inherently weak enamel structure [1].
There are multiple negative consequences of MIH, including increased caries risk,
breakdown, aesthetic problems, dental sensitivity, and tooth loss. These clinical problems, combined with the fact that MIH can be difficult to manage in children and young
adolescents from a behavior management point of view, lead to a challenging clinical
situation [2–5].
In a review of 70 global studies of MIH prevalence, the authors stated that the pooled
prevalence of MIH in children is 14.2%, with a range from 2.8% to 44% [6]. Several
dimensions of MIH have gained considerable attention from researchers. Prevalence,
etiology, and management are the most studied aspects of MIH. For the management of all
dental conditions, a reasonable understanding of the condition’s etiology is required [7].
The authors of a 70-study review emphasized that the etiology of MIH must be clearly
identified to help reduce its occurrence [6].
Children 2021, 8, 466. https://doi.org/10.3390/children8060466
https://www.mdpi.com/journal/children
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In the Arab region, in general, and in Saudi Arabia specifically, prevalence of molar
incisor hypomineralization studies are very limited. The prevalence of MIH in Jordan was
found to be 17.6%. In Iraq, a study with a sample of children ranging from 7–9 years of age
reported a prevalence of 18.6% [8,9].
In Saudi Arabia, only two prevalence studies have been published. One study was
conducted in Jeddah, a city in the western part of the country, and reported an MIH
prevalence of 8.6% among 8- to 12-year-old children [10]. Another study, which is the first
part of the present study conducted in Riyadh, the capital of Saudi Arabia, found a much
larger MIH prevalence of 40.7% in school children [11].
The etiology of MIH in several communities has been detailed in the literature. Although the etiology of MIH remains unclear to date, two theories have been suggested:
environmental insults during the prenatal, perinatal, and postnatal periods or a genetic
origin [12,13]. The genetic origin of molar incisor hypomineralization was highlighted
by Vieira and Kup, and they believe that genetic variations in genes involved in enamel
formation can be confirmed, and therefore, genetic etiology must be considered [13].
Of the MIH etiology studies, only one—a Swedish study—had a prospective design,
and it did not identify a single etiological factor [14]. A very interesting umbrella review
published recently analyzed three meta-analyses on the etiological factors of MIH [15].
None of the conducted analyses identified a single etiological factor that is significantly
associated with MIH.
A significant number of events in the pre, peri-, and postnatal periods have been
implicated in the etiology of MIH. The prenatal events include maternal medical problems, urinary tract infection in the third trimester of pregnancy, maternal anxiety, and
smoking [12]. Potential etiological factors during the perinatal period include premature
birth, cesarian section, difficult delivery, and hypoxia [16]. During the postnatal period,
potential factors related to MIH include early childhood illness, including respiratory
diseases, infections, and fever, antibiotics use, prolonged breastfeeding, and environmental
pollution [16].
It has been suggested that any systemic physiological stress can compromise ameloblast
activity at any time during enamel formation [17]. Because dental enamel is a highly specialized structure with a considerably limited regeneration ability, any disturbance during
its formation may result in a clinically visible, and irreversible defect [18].
Due to the considerably high prevalence of MIH in Saudi children, the burden of its
treatment on children, parents, and operators, and the need to prevent etiological factors
from increasing the prevalence of the condition, the aim of this study was to investigate
the possible etiological factors of MIH in Saudi children.
2. Materials and Methods
2.1. Setting and Study Population
This present study has a retrospective cross-sectional design. Prior to the study, ethical
approval was obtained from the institutional ethics committee of the College of Dentistry
at King Saud University under number (FR 0154), followed by approval from the Office
of the President General for Education in Riyadh. The sample consisted of children in the
age range of 8–10 years attending elementary schools representing all areas of the city of
Riyadh (central, northern, southern, eastern and western). Additionally, a group of similaraged children attending dental teaching hospitals at King Saud University was included.
Information sheets detailing the study’s aim, and the nature of the clinical examination
and survey questions were sent to the families of the school children prior to the clinical
examination. Informed consent was obtained from parents who were willing for their
children to participate in our study. Similarly, for the children recruited from the dental
hospital, one of the authors (N.A.-H.) approached the parents, explained the study, and
obtained informed consent from those who agreed to participate.
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The inclusion criteria included the following:
1.
2.
3.
Children aged 8–10 years
Saudi children who were lifelong residents of Riyadh
Erupted first permanent molars, and a minimum of six permanent incisors
The exclusion criteria included the following:
1.
2.
3.
4.
Children with signs of fluorosis, tetracycline staining, amelogenesis imperfecta, and
generalized enamel hypoplasia
Undergoing orthodontic treatment
Opacities confined to the incisors only
Absence of parental consent to participate
2.2. Examination
A pilot examination was performed by two trained pediatric dentists prior to the
commencement of data collection for the study. The examiners were trained and calibrated
on 20 MIH patients who were not part of the study. Intra- and inter-examiner reliability for
the dental examination of MIH patients was assessed using Cohen’s kappa score. Intraexaminer reliability was 0.91 for examiner 1 (N.A.-H.) and 0.89 for examiner 2 (M.A.). The
inter-examiner reliability score was 0.87.
During the examination, the first permanent molars, and incisors (the index teeth) were
cleaned using a cotton roll, and the children were seated on a chair facing a light source. The
children were asked to close their mouths for a short time, and then reopen it to ensure teeth
are reasonably wet prior to examination. The criteria initially developed by the European
Academy of Pediatric Dentistry in 2003, and revised in 2010 were followed [19,20].
2.3. Questionnaire
The scientific evidence was critically reviewed to identify the suspected etiological
factors for MIH that have been hypothesized. Following careful review, a structured
and validated questionnaire targeting the mothers of all the participants was designed
(Table 1). The questionnaire was completed either in a face-to-face interview or over
the phone by one of the authors (N.A.-H.). Those children whose mothers could not be
reached either because she passed away or she is divorced, were excluded. The first part
recorded demographic characteristics, including the child’s age, sex, place of residence and
birth. The second part asked about prenatal, perinatal and postnatal conditions. Delivery
method, any delivery complications, diarrhea, asthma, otitis media, jaundice, nutrition
difficulties, feeding practices, respiratory problems, antibiotic intake, and any abnormalities
encountered during the three periods were also collected. All collected data were tabulated
and entered into a FOX PRO program. The Statistical Package for Social Sciences version
20 (SPSS) was utilized to analyze and interpret the data (SPSS, Inc., Chicago, IL, USA).
Table 1. Questionnaire given to participants’ mothers.
The question given to mothers of participating children
Age?
Gender?
Place of residence and birth?
Was your child full term/pre-term?
Were there any birth complications?
Was the child delivery normal/Caesarean?
Did your child have asthma at or before the age of three?
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Table 1. Cont.
Did your child have airway infection at or before the age of three?
Did your child have otitis media at or before the age of three?
Did your child have diarrhea at or before the age of three?
The question given to mothers of participating children
Was your child diagnosed with new-born jaundice requiring treatment under light?
Did your child have nutrition problems?
Was your child breastfed?
Did your child receive treatment with antibiotics at or before the age of three?
Any other medical events you would like to mention?
3. Results
A total of 893 (461 female and 432 male) 8- to 10-year-old children were examined,
and their parents completed the questionnaire in full. The total number approached was
924, however we only included the 893 who completed the questionnaire by their mothers.
A total of 362 children (168 males and 194 females) had MIH, for a prevalence of 40.5%.
The sample (893) included 273 (30.6%) 8-year-old, 320 (35.8%) 9-year-old, and 300 (33.6%)
10-year-olds. The 362 MIH-affected children were distributed by age as follows: 105 (29%)
were 8 years old, 143 (39.5) were 9 years old, and 114 (31.5) were 10 years old. When the
distribution of defects was examined according to age and sex, no significant difference
was found. (Table 2).
Table 2. MIH distribution according to age and sex.
MIH + (362)
Sex
Age
MIH- (531)
Total (893)
n
%
n
%
n
%
Male
168
38.9
264
61.1
432
48.4
Female
194
42.1
267
57.9
461
51.6
8 years
105
29
168
31.64
273
30.6
9 years
143
39.5
177
33.33
320
35.8
10 years
114
31.5
186
35.02
300
33.6
p-Value
0.341
0.167
MIH+ = affected with MIH, MIH- = not affected with MIH.
The distribution of the etiological factors in the children affected with MIH (MIH+)
and not affected (MIH-), and the association of etiological factors with MIH are presented
in Table 3. The chi-square test showed that the presence of jaundice shortly after birth was
significantly associated with MIH (p = 0.04). All other investigated etiological factors were
not significantly associated with MIH.
Multivariate Binary logistic regression analysis was applied. The dependent variables
were MIH+ (affected) and MIH- (not affected), and explanatory independent variables
(age, gender and etiological factors) were considered significant if the p-value < 0.05
(Table 4). According to logistic regression full model, only newborn jaundice was found to
be significantly associated with MIH in children (OR = 1.35, p = 0.047). The goodness-of-fit
of logistic regression full model confirmed by the Hosmer and Lemeshow test was not
significant (p = 0.678), and 60.2% of the data were correctly classified.
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Table 3. Distribution of etiological factors in children with and without MIH.
MIH + (362)
Etiological Factors
Premature birth
Childbirth complications
Diarrhea
Asthma
Otitis media
Normal birth
Newborn jaundice
Airway infection
Nutrition problems
Breast feeding
Antibiotics use
MIH- (531)
Total (893)
n
(%)
n
(%)
n
(%)
yes
17
4.7
25
4.7
42
4.7
no
345
95.3
506
95.3
851
95.3
yes
16
4.4
20
3.8
36
4
no
346
95.6
511
96.2
857
96
yes
49
13.5
79
14.9
128
14.3
no
313
86.5
452
85.1
765
85.7
yes
68
18.8
91
17.1
159
17.8
no
294
81.2
440
82.9
734
82.2
yes
68
18.8
86
16.2
154
17.2
no
294
81.2
445
83.8
739
82.8
yes
312
86.2
457
86.1
769
86.1
no
50
13.8
74
13.9
124
13.9
yes
117
32.3
138
26.0
255
28.6
no
245
67.7
393
74.0
638
71.4
yes
14
3.9
14
2.6
28
3.1
no
348
96.1
517
97.4
865
96.9
yes
3
0.8
2
0.4
5
0.6
no
359
99.2
529
99.6
888
99.4
yes
297
82.0
442
83.2
739
82.8
no
65
18.0
89
16.8
154
17.2
yes
205
56.8
299
82.8
504
56.5
no
97
26.9
167
46.3
264
29.6
I don’t know
60
16.6
64
17.7
124
13.9
p-Value
0.993
0.626
0.574
0.528
0.368
0.949
0.040 *
0.300
0.374
0.643
0.107
MIH+ = affected with MIH, MIH- = not affected with MIH, * indicates statistical significance.
Table 5 showed the analysis of forward stepwise multivariate binary logistic regression,
which confirmed that the jaundice is significantly associated with MIH (OR = 1.36, p = 0.04).
The goodness of fit of the reduced model confirmed with the Hosmer and Lemeshow test
was not significant (p = 0.1245), but the test model was significant (p = 0.04), and 59.5% of
the data were correctly classified.
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Table 4. Multivariate binary logistic regression of etiological factors for MIH.
Multivariate Binary Logistic Regression Analysis (Full Model)
Explainatory Variable
B
OR
p-Value
95% CI
Age
−0.028
0.973
0.748
0.748–1.152
Gender
0.146
1.157
0.299
0.299–1.523
Premature birth
−0.042
0.959
0.899
0.497–1.848
Birth complications
0.088
1.092
0.802
0.548–2.175
Diarrhea
−0.175
0.840
0.391
0.564–1.251
Asthma
0.127
1.136
0.491
0.790–1.631
Otitis media
0.160
1.173
0.396
0.811–1.697
Normal birth
−0.037
0.963
0.854
0.648–1.433
Jaundice
0.300
1.349
0.047 *
0.999–1.822
Nutritional problems
0.621
1.861
0.504
0.301–11.499
Airway infection
0.347
1.415
0.376
0.656–3.054
Brest feeding
0.212
1.236
0.800
0.241–6.345
Antibiotics use
−0.048
0.953
0.743
0.717–1.268
Constant
−0.280
0.756
0.727
Goodness of Fit of the Model
Tests of
Model
Coefficients
Hosmer and
Lemeshow
Test
Percentage
Correct
Classification
0.798
0.678
60.2%
* indicates statistical significance.
Table 5. Stepwise (Wald) Multivariate Binary logistic regression of etiological factors for MIH.
Forward Stepwise (Wald) Multivariate Binary Logistic Regression
Equation (Reduced Model)
Explainatory Variable
B
OR
p-Value
95% CI
Newborn Jaundice
0.307
1.360
0.040 *
1.014–1.824
Constant
−0.473
0.623
0.000
Model Goodness of Fit
Tests of
Model
Coefficients
Hosmer and
Lemeshow
Test
Percentage
Correct
Classification
0.04
0.124
59.50%
* indicates statistical significance.
4. Discussion
The findings of the present study highlight the relatively high prevalence of MIH
among school children in the capital, and largest city of Saudi Arabia, Riyadh. We found a
prevalence of 40% in the studied sample. In terms of international studies, this number
is comparable to a prevalence study in Brazilian children, which found a prevalence of
40.2% in a sample of 7- to 13-year-olds [21]. In contrast, in a sample from Jeddah, located in
western Saudi Arabia, the reported prevalence was 8.6% in 8- to 12-year-old children [10].
The wide variation between the two studies’ findings can be explained by the differences
in sampling techniques. The sample size in our study was almost 3.5 times the size of the
sample in the Jeddah study, and, according to Elfrink et al., a minimum of 300 subjects is
required to determine MIH prevalence [22]. Additionally, their study used a convenience
sample of patients attending dental clinics only, and all nationalities were included. In
the current study, a random sample of children from schools in all areas of the city, and
children attending a dental hospital was invited to participate. In the studied sample, no
significant differences in MIH prevalence were found between sex and age groups, which
is in agreement with previous similar studies [10,23,24].
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The main aim of the present study was to identify the possible etiological association
of MIH with pre, peri-, and postnatal events in Saudi school children. It is important to
mention that such associations are generally difficult to identify, and conclusions should be
carefully considered.
We relied mainly on mothers’ recall of any abnormalities. The risk was minimized as
much as possible through structured questioning conducted by one investigator, which
could help the mother recall any related factors. Additionally, the questionnaires information was only taken from the child’s mothers. Fathers or other members of the family were
not questioned because they would induce higher risk of recall bias when asked about
pre, peri-, and post-natal events. All suggested etiological factors that were described in
previous scientific literature were considered [10,16,17,23]
In the present sample, only one of the suggested factors show statistically significant
association with MIH: newborn jaundice. Multivariate logistic regression further confirmed
the positive association between MIH and jaundice in the current sample of school children
from Riyadh.
Birth complications, prematurity, and cesarean section did not show a statistical
association with MIH. Fatturi et al. reviewed 24 observational studies of MIH etiology.
The authors concluded that maternal psychological illness, delivery complications, and
cesarean section showed significant correlations with MIH [16]. However, this result must
be interpreted with caution, because it included only observational studies, which have
a high risk of bias and inconsistency [15]. Low birth weight neonates had a three times
higher risk of MIH in a number of other observational studies, and a meta-analysis [25].
On the other hand, in a study on the association between MIH, and peripartum events in a
French sample, the authors reported that there was no association between prematurity
and MIH [26]. Additionally, Allazzam et al. agreed with the present findings, and reported
no significant association between peri- and prenatal events and MIH [10].
Respiratory problems, asthma and early childhood illness were not statistically significant etiological factors in the occurrence of MIH in our sample of children. Silva et al.
reported that early childhood disease, specifically fever, might be an offending etiological
factor in MIH; however, they suggested that further prospective studies with better control
of confounding factors are necessary to better understand the real etiology of MIH [12,17].
It has been explained that hypoxic conditions, which are theoretically associated with
respiratory disorders, can lead to disturbances of amelogenesis [12]. Drugs, especially
antibiotics, have been investigated as a possible etiological factor for MIH. In a systematic
review, medications were not significantly associated with MIH, which is in agreement
with our findings [27].
In a multivariate logistic regression model, we found a significant association between
jaundice and MIH with a correlation coefficient of 0.3. This association is not considered
very strong; however, it is statistically significant. Jaundice, which is also known as
hyperbilirubinemia, can be detected when the total serum level of bilirubin exceeds 5 mg
per dL, a condition that is not uncommon among newborns [28,29]. It is a common practice
in children’s hospitals to screen the newborn for jaundice, and the treatment modality
for those children with mild hyperbilirubinemia is phototherapy which was the case in
our sample whose mothers were questioned specifically about treatment under light for
jaundice [30].
The effect of newborn jaundice on dental disorders and on MIH specifically has rarely
been considered in previous etiological studies. In the reviewed literature, we found
only two studies that mentioned jaundice, and explicitly asked about it on a parental
questionnaire [10,23]. Neither study correlated jaundice with the presence of MIH in their
samples; however, it is worth mentioning that in both study groups, the prevalence of
jaundice and MIH were much lower than those in our present study. To date, the etiological
mechanism underlying MIH is still not understood. Both environmental changes and
genetic predisposition are possible etiologies. A complete analysis of the factors that lead to
Children 2021, 8, 466
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MIH is crucial to improve preventive and treatment protocols for such problematic dental
conditions, specifically in children.
5. Conclusions
In conclusion, within the limitations of the current study, which was a retrospective
study with a known recall bias risk, we highlighted for the first time that jaundice is another
possible perinatal etiological factor in the occurrence of MIH in the examined children.
Further prospective well-designed longitudinal studies that use accurate medical documentation are needed to confirm the etiopathogenesis of molar incisor hypomineralization.
Author Contributions: Conceptualization, L.A., N.A.-H., and L.L.B.; methodology, L.A., N.A.-H.,
L.L.B.; software, L.L.B.; validation, L.L.B., N.A.-H. and L.A.; formal analysis, L.B.; investigation,
M.A.; resources, L.A.; data curation, L.B.; writing—original draft preparation, L.A.; writing—review
and editing, L.A.; project administration, N.A.-H. All authors have read and agreed to the published
version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted according to the guidelines of the
Declaration of Helsinki, ethical approval was obtained from the institutional ethics committee of the
College of Dentistry at King Saud University under number (FR 0154), followed by approval from
the Office of the President General for Education in Riyadh.
Informed Consent Statement: Informed consent was obtained from parents who were willing for
their children to participate in our study.
Data Availability Statement: Data supporting the findings of the present study can be requested
from authors.
Acknowledgments: Authors would like to thank Nasser Al Moflehi, for his help in statistical analysis.
We would also like to thank the College of Dentistry Research Center and the Deanship of Scientific
Research at King Saud University, Riyadh, Saudi Arabia for their support.
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Weerheijm, K.L.; Jälevik, B.; Alaluusua, S. Molar-incisor hypomineralisation. Caries Res. 2001, 35, 390–391. [CrossRef]
Fayle, S.A. Molar incisor hypomineralisation: Restorative management. Eur. J. Paediatr. Dent. 2003, 4, 121–126.
Humphreys, J.; Albadri, S. Management of molar incisor hypomineralisation (MIH): A 1-year retrospective study in a specialist
secondary care centre in the UK. Children 2020, 7, 252. [CrossRef]
Americano, G.C.; Jacobsen, P.E.; Soviero, V.M.; Haubek, D. A systematic review on the association between molar incisor
hypomineralization and dental caries. Int. J. Paediatr. Dent. 2017, 27, 11–21. [CrossRef] [PubMed]
Murri Dello Diago, A.; Cadenaro, M.; Ricchiuto, R.; Banchelli, F.; Spinas, E.; Checchi, V.; Giannetti, L. Hypersensitivity in molar
incisor hypomineralization: Superficial infiltration treatment. Appl. Sci. 2021, 11, 1823. [CrossRef]
Zhao, D.; Dong, B.; Yu, D.; Ren, Q.; Sun, Y. The prevalence of molar incisor hypomineralization: Evidence from 70 studies. Int. J.
Paediatr. Dent. 2018, 28, 170–179. [CrossRef] [PubMed]
Hernandez, M.; Boj, J.R.; Espasa, E. Do we really know the prevalence of MIH? J. Clin. Pediatr. Dent. 2016, 40, 259–263. [CrossRef]
[PubMed]
Zawaideh, F.I.; Al-Jundi, S.H.; Al-Jaljoli, M.H. Molar incisor hypomineralisation: Prevalence in Jordanian children and clinical
characteristics. Eur. Arch. Paediatr. Dent. 2011, 12, 31–36. [CrossRef]
Ghanim, A.; Mariño, 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. Int. J. Paediatr. Dent. 2013, 23, 2–12. [CrossRef]
Allazzam, S.M.; Alaki, S.M.; El Meligy, O.A. Molar incisor hypomineralization, prevalence, and etiology. Int. J. Dent. 2014, 2014,
234508. [CrossRef]
Al-Hammad, N.S.; Al-Dhubaiban, M.; Alhowaish, L.; Bello, L.L. Prevalence and clinical characteristics of molar-incisorhypomineralization in school children in riyadh, Saudi Arabia. Int. J. Med. Sci. Clin. Invent. 2018, 5, 3570–3576. [CrossRef]
Alaluusua, S. Aetiology of Molar-Incisor Hypomineralisation: A systematic review. Eur. Arch. Paediatr. Dent. 2010, 11, 53–58.
[CrossRef]
Vieira, A.R.; Kup, E. On the etiology of molar-incisor hypomineralization. Caries Res. 2016, 50, 166–169. [CrossRef] [PubMed]
Fagrell, T.G.; Ludvigsson, J.; Ullbro, C.; Lundin, S.A.; Koch, G. Aetiology of severe demarcated enamel opacities–an evaluation
based on prospective medical and social data from 17,000 children. Swed. Dent. J. 2011, 35, 57–67.
Children 2021, 8, 466
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
9 of 9
Bandeira Lopes, L.; Machado, V.; Botelho, J.; Haubek, D. Molar-incisor hypomineralization: An umbrella review. Acta Odontol.
Scand. 2021, 1–11. [CrossRef]
Fatturi, A.L.; Wambier, L.M.; Chibinski, A.C.; Assunção, L.; Brancher, J.A.; Reis, A.; Souza, J.F. A systematic review and metaanalysis of systemic exposure associated with molar incisor hypomineralization. Community Dent. Oral Epidemiol. 2019, 47,
407–415. [CrossRef]
Silva, M.J.; Scurrah, K.J.; Craig, J.M.; Manton, D.J.; Kilpatrick, N. Etiology of molar incisor hypomineralization—A systematic
review. Community Dent. Oral Epidemiol. 2016, 44, 342–353. [CrossRef]
Sidaly, R.; Schmalfuss, A.; Skaare, A.B.; Sehic, A.; Stiris, T.; Espelid, I. Five-minute Apgar score ≤ 5 and Molar Incisor Hypomineralisation (MIH)—A case control study. BMC Oral Health 2016, 17, 25. [CrossRef]
Weerheijm, K.L.; Duggal, M.; Mejàre, I.; Papagiannoulis, L.; Koch, G.; Martens, L.C.; Hallonsten, A.L. Judgement criteria for
molar incisor hypomineralisation (MIH) in epidemiologic studies: A summary of the European meeting on MIH held in Athens,
2003. Eur. J. Paediatr. Dent. 2003, 4, 110–113. [PubMed]
Lygidakis, N.A.; Wong, F.; Jälevik, B.; Vierrou, A.M.; Alaluusua, S.; Espelid, I. Best Clinical Practice Guidance for clinicians
dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD policy document. Eur. Arch. Paediatr.
Dent. 2010, 11, 75–81. [CrossRef]
Soviero, V.; Haubek, D.; Trindade, C.; Da Matta, T.; Poulsen, S. Prevalence and distribution of demarcated opacities and their
sequelae in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children. Acta Odontol. Scand. 2009, 67, 170–175.
[CrossRef]
Elfrink, M.E.; Ghanim, A.; Manton, D.J.; Weerheijm, K.L. Standardised studies on Molar Incisor Hypomineralisation (MIH) and
Hypomineralised Second Primary Molars (HSPM): A need. Eur. Arch. Paediatr. Dent. 2015, 16, 247–255. [CrossRef]
Mishra, A.; Pandey, R.K. Molar incisor hypomineralization: An epidemiological study with prevalence and etiological factors in
Indian pediatric population. Int. J. Clin. Pediatr. Dent. 2016, 9, 167–171. [CrossRef] [PubMed]
Cho, S.Y.; Ki, Y.; Chu, V. Molar incisor hypomineralization in Hong Kong Chinese children. Int. J. Paediatr. Dent. 2008, 18, 348–352.
[CrossRef] [PubMed]
Wu, X.; Wang, J.; Li, Y.H.; Yang, Z.Y.; Zhou, Z. Association of molar incisor hypomineralization with premature birth or low birth
weight: Systematic review and meta-analysis. J. Matern. Fetal. Neonatal. Med. 2020, 33, 1700–1708. [CrossRef] [PubMed]
Garot, E.; Manton, D.; Rouas, P. Peripartum events and molar-incisor hypomineralisation (MIH) amongst young patients in
southwest France. Eur. Arch. Paediatr. Dent. 2016, 17, 245–250. [CrossRef] [PubMed]
Serna, C.; Vicente, A.; Finke, C.; Ortiz, A.J. Drugs related to the etiology of molar incisor hypomineralization: A systematic review.
J. Am. Dent. Assoc. 2016, 147, 120–130. [CrossRef] [PubMed]
Lauer, B.J.; Spector, N.D. Hyperbilirubinemia in the newborn. Pediatr. Rev. 2011, 32, 341–349. [CrossRef]
Wan, A.; Daud, S.M.; Teh, S.; Choo, Y.; Kutty, F. Management of neonatal jaundice in primary care. Malays Fam. Physician 2016,
11, 16–19.
Muchowski, K.E. Evaluation and treatment of neonatal hyperbilirubinemia. Am. Fam. Physician 2014, 89, 873–878.