Objetivo: Evaluar el manejo terapéutico seleccionado por los estudiantes de pregrado, egresados y docentes de una Universidad privada de Lima en piezas dentarias con HIM Materiales y métodos: En este estudio se trabajo con 151 participantes, siendo estudiantes de pregrado, egresados y docentes entre los 20 a 42 años de una Universidad Privada en Chorrillos, Lima-Perú. Se les aplicó un cuestionario el cual se subdividió en 2 fases: tipo de material y tipo de preparación cavitaria con 3 casos de HIM con diferente grado de severidad. Para el análisis univariado, se procedió a obtener la estadística descriptiva, frecuencias absolutas y relativas (P<0.05). Resultados: En el caso 1 el tratamiento más seleccionado por todos los encuestados fue “Sellante de fisuras a base de material de ionómero de vidrio” siendo en pregrado 31(68.9%), egresados 37(47.43%) y docentes 19(67.86%). En el caso 2 el tratamiento más seleccionado fue “corona preformada” siendo en pregrado de 20(44.45%), egresados de 33(42.30%) y docentes 15(53.57%). En el caso 3 en la primera opción “Remover solo el esmalte blando y dañado” fue más elegida por egresados 45(57.69%). En la segunda opción “Remover mayor sustancia dental, pero dejar el borde de la preparación en esmalte hipomineralizado” fue más elegida por pregrado 27(60%). En cuanto a la tercera opción, “Remover todo el esmalte afectado con HIM y dejar el borde de la preparación en esmalte sano", fue más elegida por docentes 7(25%). También se observa que si hubo diferencia significativa entre el nivel de formación con manejo terapeutico. (p=0,000). Conclusiones: En base a los resultados encontrados es posible concluir que el tratamiento para HIM debe ser elegido de acuerdo a las características individuales de la pieza afectada, las cuales, determinaran el tipo de preparación cavitaria o el tipo de material a utilizar. / Objective: To evaluate the therapeutic management selected by undergraduate students, graduates and teachers of a private University of Lima in dental pieces with HIM. Materials and methods: In this study worked with 151 participants, being undergraduate students, graduates and teachers between the ages of 20 and 42 of a Private University in Chorrillos, Lima-Peru. A questionnaire was applied which was subdivided into 2 phases: type of material and type of cavitary preparation with 3 cases of HIM with different severity. For the univariate analysis, the descriptive statistics, absolute and relative frequencies were analyzed (P <0.05). Results: In case 1, the treatment most selected by all respondents was “glass ionomer fissure sealants” being undergraduate 31 (68.9%), graduates 37 (47.43%) and teachers 19 (67.86%). In case 2, the most selected treatment was “preformed crown” being undergraduate of 20 (44.45%), graduates of 33 (42.30%) and teachers 15 (53.57%). In case 3, in the first option “Remove only soft and damaged enamel”, it was most chosen by graduates 45 (57.69%). In the second option "Remove more dental substance, but leave the edge of the preparation in hypomineralized enamel" was most chosen by undergraduate 27 (60%). As for the third option, "Remove all the enamel affected with HIM and leave the edge of the preparation in healthy enamel", was most chosen by teachers 7 (25%). It is also observed that if there was a significant difference between the level of training with therapeutic management (p = 0,000). Conclusions: Based on the results found, it is possible to conclude that the treatment for HIM should be chosen according to the individual characteristics of the affected piece, which will determine the type of cavitary preparation or the type of material to be used. / Tesis

Indiana University-Purdue University Indianapolis (IUPUI) / Molar Hypomineralization (MH) of the first permanent molars (FPMs) and the second primary molars (SPMs) is a common developmental defect of enamel, with global prevalence of 14% and 5% respectively. Children with MH represent a special pediatric population because their affected molars have extreme susceptibility to enamel breakdown, decay and tooth sensitivity. Although the problem of MH has been described almost twenty years ago mainly through reports from Europe, there is very little information about the problem from the USA. In this dissertation, MH was explored both from the perspectives of pediatric dentists’ (PDs) and at population level. The majority of the survey respondents perceived MH prevalence to be <10% in their clinical practice (62%). The most cited clinical challenge in managing MH teeth was “long-term success of restorations” (79%). When analyzed individually, responses differed significantly for different demographics and educational characteristics of the respondents (p<0.05). At population level, MH of the FPMs (Molar Incisor Hypomineralization (MIH) cohort: 337 schoolchildren, average age 9 years) and of the SPMs (Hypomineralized Second Primary Molar (HSPM) cohort: 423 schoolchildren, average age 7 years) had prevalence estimates of 13% and 6% respectively. In the MIH cohort, water fluoridation or non-Hispanic Black race/ethnicity was significantly associated with higher collective prevalence of enamel defect (EDs) (P<0.05), but not with the prevalence of MH of the FPMs. In the HSPM cohort, race/ethnicity was significantly associated with higher overall prevalence of EDs of SPMs, but not with the HSPM prevalence. Older age group (>10 years), living in central Indiana, and water fluoridation were significantly associated with higher overall prevalence of EDs (P<0.01), but not with the HSPM prevalence. Caries experience was significantly higher in children with MH of FPMs and/or SPMs than in the group without MH. We concluded that USA pediatric dentists’ respondents were well aware of the MH problem, but demonstrated discrepancies in different aspects of the MH problem. At population level, MIH and HSPM were common presentation with prevalence estimates similar to the global figures. Certain demographic characteristics were significantly associated with the overall prevalence of the enamel defects of the examined teeth.

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Molar Incisor Hypomineralization definieras som ett specifikt tillstånd orsakat av störningar i den tidiga fasen av emaljbildning av en eller flera permanenta första molarer med eller utan involvering av permanenta incisiver. Tidigare studier har visat att standardiserad intraoral fotograferingsteknik kan vara användbar för epidemiologiska studier av emaljdefekter. Denna studies syfte var att utveckla och utvärdera en fotografisk klassificering av allvarlighetsgraden av Molar Incisor Hypomineralization genom att studera metodens validitet och reliabilitet. 164, 10-12 åriga svenska barn granskades fotografiskt avseende prevalensen av Molar Incisor Hypomineralization. Först granskades endast första molarens ocklusalyta, därefter ocklusal- och buckalyta. Granskningarna jämfördes sedan med en tidigare utförd klinisk registrering, baserad på etablerade kriterier. Den fotografiska metodens validitet och reliabilitet beräknades. Vid beräkning av validiteten framgick att överensstämmelsen mellan den fotografiska och kliniska registreringen låg mellan 82-84 % på individnivå. Sensitiviteten för den fotografiska diagnostiken av ocklusalytorna var 48 % och specificiteten 95 %. Motsvarande siffror då buckalytorna inkluderades var 73 % och 88 %. Metodens reliabilitet resulterade i Cohens Kappa koefficienter som motsvarade ”moderat” och ”good” inom Kappa statistiken. Fotografisk klassificering bedöms användbar för diagnostisering av molar incisor hypomineralization, förutsatt att registreringen föregås av noggrann diagnostisk träning och kalibrering. / Molar Incisor Hypomineralization is defined as a specific condition caused by disturbance in the early phase of enamel formation in one or more of the permanent first molars, with or without the involvement of permanent incisors. Previous studies have shown that standardized intraoral photographic technique can be useful in epidemiological studies of enamel defects. The aim of this study was to develop and evaluate a photographic classification of the severity of Molar Incisor Hypomineralization by studying the validity and reliability of the methods. 164, 10 – 12 year old Swedish children were examined photographically for Molar Incisor Hypomineralization prevalence. The first examination only included the occlusal surface of the first molars, thereafter the occlusal and the buccal surfaces were examined. The findings from the photographical examinations were compared to a previously performed clinical registration, based on recognized criteria. The photographical method´s validity and reliability was calculated. The agreement between the photographic and the clinical examinations varied between 82-84 % on individual level. The sensitivity for the photographic examination of the occlusal surface only, was 48% and the specificity 95%. Corresponding results for occlusal and buccal surface were 73% and 88%. The reliability of the method, calculated using the Cohens Kappa coefficient, was judged as “moderate” to “good”. The photographic diagnostic method seems to be useful for diagnosis of Molar Incisor Hypomineralization. However, careful diagnostic training and calibration prior to registration is necessary.

Background: Treatment of oral diseases can have a long-lasting impact on a child’s life well beyond its childhood years. The purpose of this study was to compare the impact of treatment on the oral-health-related quality of life (OHRQoL) of children with severe caries and severe molar incisor hypomineralization (MIH). Methods: A total of 210 children (mean age 9 years; 49% female) with severe caries (inner third of dentin) and severe MIH (post-eruptive breakdown, crown destruction) were included in the study. Both groups were matched according to age, gender, and social status. The German version of the Child Perception Questionnaire for 8–10-year-olds (CPQ-G8–10) was used before and after treatment to analyze the impact on OHRQoL. Results: Patients with severe MIH showed a significantly higher total CPQ score (17.8 (±10.6)) before treatment compared to the caries group (13.8 (±14.3)). The mean CPQ score in all subdomains decreased significantly after therapy in the MIH group. Children with severe carious lesions had similar results except in the domain “functional limitations”, as treatment led to only minor changes (2.9 (±3.6) to 2.2 (±2.6)). Conclusions: Despite a narrower treatment spectrum, patients with severe MIH experienced a greater overall improvement in OHRQoL compared to the caries group.

Background: Molar–incisor hypomineralization (MIH) has a strong negative effect on oralhealth-related quality of life (OHRQoL). Malformed teeth can be hypersensitive, and the discoloration might affect children’s appearances, reducing their well-being. The purpose of the study was to investigate how hypomineralized incisors and molars differ in children’s perceived OHRQoL. Materials and Methods: 252 children aged 7–10 years old were included and subdivided into three equal groups (n = 84). Group A included children with asymptomatic molars and affected incisors. Group B included children presenting only affected molars. Group C was the control group, with children showing no MIH. All participants were asked to complete the German version of the Child Perceptions Questionnaire (CPQ-G8-10) to measure OHRQoL. Results: Participants in the posterior group showed a median total CPQ of 13.4 (±1.7), which was significantly higher than scores in the anterior and control group, which showed a median total CPQ of 8.4 (±1.4) and 4.2 (±0.7), respectively. Children in the posterior group suffered more from oral symptoms and functional limitations, whereas the anterior group dealt more with social and emotional well-being problems. Conclusions: The position of the MIH-affected teeth causes different influences on perceived OHRQoL.

El objetivo del estudio fue evaluar los factores etiológicos asociados con la hipomineralización incisivo molar en escolares de un centro educativo estatal, Chiclayo, 2023. El estudio fue observacional, transversal y de nivel explicativo, la población de estudio fue de 313 niños de 7 a 9 años de edad y sus madres. Se incluyeron niños matriculados el 2023, de ambos sexos, con presencia de al menos una primera molar permanente, se excluyeron niños cuyas madres no aceptaron participar en el estudio mediante firma del consentimiento informado. Se realizó un examen clínico a los niños utilizando la codificación para HIM, así mismo, se aplicó un cuestionario presencial a las madres que cuenta con la validez y confiabilidad adecuados. Se obtuvo una prevalencia de HIM de 7.7%, predominando las opacidades blancas/cremas (código 2) con 37.5%, seguido de las opacidades amarillo/ marrón con un 16.7% y caries atípica con un 12.5%. Se concluyó, respecto a factores etiológicos de HIM, que obtuvieron significancia estadística, en prenatales el peso del niño al nacer, en posntnatales la ocurrencia de fiebre alta en el niño desde el nacimiento hasta los 4 años. / The aim of the study was to evaluate the etiological factors associated with molar incisor hypomineralization in school children in a state school, Chiclayo, 2023. The study was observational, cross-sectional and of explanatory level, the study population was 313 children from 7 to 9 years of age and their mothers. Children enrolled in 2023, of both sexes, with the presence of at least one permanent first molar were included; children whose mothers did not agree to participate in the study by signing the informed consent form were excluded. A clinic al examination of the children was performed using the coding for HIM, and a face-to-face questionnaire was applied to the mothers with adequate validity and reliability. A prevalence of HIM of 7.7% was obtained, predominantly white/cream opacities (code 2) with 37.5%, followed by yellow/brown opacities with 16.7% and atypical caries with 12.5%. It was concluded, with respect to etiological factors of HIM, that they obtained statistical significa nce, in prenatal the weight of the child at birth, in postnatal the occurrence of high fever in the child from birth to 4 years of age.

Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages. Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years). Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay. Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys. Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.