Knowledge, Attitude and Practice Regarding Molar Incisor Hypomineralization and Its Management Among Pediatric Dentist

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 4, July – 2025, Page No. : 140 - 149 Corresponding Author: Dr Syeda Husna Noorein, ijdsir, Volume – 8 Issue - 4, Page No. : 140 - 149 Page140 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Knowledge, Attitude and Practice Regarding Molar Incisor Hypomineralization and Its Management Among Pediatric Dentist 1Dr Vivek Dhruv Kumar, Professor, Department of Pediatric and Preventive Dentistry, V S Dental College, Bengaluru, Karnataka 2Dr Syeda Husna Noorein, Post Graduate Resident Department of Pediatric and Preventive Dentistry, V S Dental College, Bengaluru, Karnataka 3Dr Suma G, Professor, Department of Pediatric and Preventive Dentistry, V S Dental College, Bengaluru, Karnataka 4Dr Zuha Naseem, Post Graduate Resident, Department of Pediatric and Preventive Dentistry, V S Dental College, Bengaluru, Karnataka Corresponding Author: Dr Syeda Husna Noorein, Post Graduate Resident Department of Pediatric and Preventive Dentistry, V S Dental College, Bengaluru, Karnataka Citation of this Article: Dr Vivek Dhruv Kumar, Dr Syeda Husna Noorein, Dr Suma G, Dr Zuha Naseem, “Knowledge, Attitude and Practice Regarding Molar Incisor Hypomineralization and Its Management Among Pediatric Dentist”, IJDSIRJuly – 2025, Volume – 8, Issue – 4, P. No. 140 – 149. Copyright: © 2025, Dr Syeda Husna Noorein, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Background: Molar Incisor Hypomineralization (MIH) poses a considerable challenge in pediatric dentistry, as it involves developmental enamel defects affecting the first permanent molars and incisors. These defects lead to discoloration, structural weaknesses, and heightened susceptibility to caries, sensitivity, and wear. The compromised enamel often lacks the typical strength and resistance to acids, making affected teeth more prone to demineralization and decay. Additionally, MIH can cause functional and aesthetic concerns for children, potentially impacting their self-esteem and oral health-related quality of life. This study aims to evaluate the knowledge and practices of pediatric dentists regarding the management of initial carious lesion in children with Molar Incisor Hypomineralization (MIH). Materials and Methodology: An online questionnaire survey was performed among a minimum of 100 pediatric dentists. Using google form, Responses were recorded was statistically analyzed. Results and Conclusion: The average knowledge on MIH was considered better among pediatric dentists when compared with the post graduates and least amongst the general dentists. Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 Page141 These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH. Keywords: Molar Incisor Hypomineralization (MIH), management, RMGIC, survey Introduction Molar incisor hypomineralization (MIH) was first described by Weerheijm et al 1 in 2001 and refers to qualitative developmental enamel defects, which affect one or more first permanent molars and, less frequently, the upper permanent incisors. It clinically presents as white–creamy or yellow–brown demarcated opacities, and it is combined with structural loss, resulting in posteruptive enamel breakdown (PEB) in severely affected enamel. It poses a considerable challenge in pediatric dentistry, as it involves developmental enamel defects affecting the first permanent molars and incisors. These defects lead to discoloration, structural weaknesses, and heightened susceptibility to caries, sensitivity, and wear. The compromised enamel often lacks the typical strength and resistance to acids, making affected teeth more prone to demineralization and decay. Additionally, MIH can cause functional and aesthetic concerns for children, potentially impacting their self-esteem and oral health-related quality of life. However, the management approach can vary among pediatric dentists, with some favouring more conservative treatments, such as fluoride therapies, while others may prefer more invasive methods like restorations or sealants, especially in cases with deeper lesions. This disparity in the approach to treating initial carious lesions in MIH stems from the variety of treatment options available, as well as differing clinical experiences and guidelines among practitioners. This study aims to evaluate the knowledge and practice of pediatric dentists regarding the management of initial carious lesion in children with Molar Incisor Hypomineralization (MIH). Material and Methods The study was performed among 100 pediatric dentist including pediatric post graduate students. Google forms software survey was used to create an online English questionnaire. A questionare was designed based on the existing validated questionnaire 2-4. The questionnaire was first piloted by a group of postgraduate students to ensure that the questions were easy to understand and took no longer than 5 min to complete. The respondents could reply anonymously via a google form questionnaire link. The google form link was sent using WhatsApp, personal email and was put up on pediatric forum of various social platforms like Facebook, twitter and Instagram. The email declared by the participants was optional. The inclusion criteria for this questionnaire study was practising pediatric dentists and pediatric post graduate students. The exclusion criteria included interns, general dental practioners and specialists other and pediatric dentist. Questionnaire Instruments The Questionnaire consisted of three parameters to assess the knowledge, attitude and practise. In knowledge the possible etiologic factors related to MIH was considered as it is considered to be multifactorial in nature, in attitude section pediatric dentists were asked if they felt confident in identifying MIH, their challenges encountered. And in practise individual questions on different aspects of procedure like favourable material of choice for restoration, when is the need for preventive treatment, what kind of remineralizing paste and what Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 Page142 instruction is usually advised, how frequent is the recall visit. The following 19 questions were evaluated by a group of 3 experienced pediatric dentists to assess the various treatment option being used. Analysis Data were entered into an excel spreadsheet by google forms. Statistical analysis was performed using IBM SPSS software. Descriptive analysis (simple frequency distribution and percentage) was determined significant difference between the 2 study groups (pediatric dentists and postgraduates) was checked using Peasrson’s chisquare test. Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Page143 Results and Discussion From 100 samples 6 general dentists with 43 pediatric dentist and 51 postgraduates had participated in the survey. Knowledge: Q1. May be No Yes ꭓ2 P-Value n % n % n % Other 0 0% 11 25% 2 4% 16.258 0.003* Pediatric Dentist 0 0% 11 25% 23 46% Postgraduate Student 6 100% 22 50% 26 50% Total 6 100% 43 100% 51 100% Statistically significant association was observed between knowledge and experience of MIH (P<0.01). Q2 Other Pediatric Dentist Post Graduate Student n % n % n % Acute medical conditions that affects the mother or child during pregnancy 1 10% 4 10% 5 10% Acute medical conditions that affects the mother or child during pregnancy; Believed to be related to systemic disturbances during tooth development 1 20% 9 20% 10 20% Acute medical conditions that affects the mother or child during pregnancy; Believed to be related to systemic disturbances during tooth development; Exclusively caused by genetic factors 1 14% 6 14% 7 14% Believed to be related to systemic disturbances during tooth development 3 48% 21 48% 24 48% Exclusively caused by genetic factors 0 8% 3 8% 4 8% Total 6 100% 43 100% 51 100% Q4 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Confident in diagnosis, but less confident in treatment planning and communication 6 100% 22 50% 39 77% 29.180 <0.001* Highly confident in all aspects of MIH management 0 0% 22 50% 4 8% Not confident in any aspect of MIH management 0 0% 0 0% 8 15% Total 6 100% 43 100% 51 100% *denotes significant association Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Page144 Q5 Other Pediatric Dentist Post Graduate Student ꭓ2 PValue n % n % n % Lack of diagnostic tools and difficulty in diagnosis 2 33% 10 23% 24 46% 7.553 0.109 Managing patient behavior, achieving adequate anesthesia, and obtaining good isolation 2 33% 25 59% 18 35% Primarily patient non-compliance 2 33% 8 18% 10 19% Total 6 100% 43 100% 51 100% Q6 Other Pediatric Dentist Post Graduate Student ꭓ2 PValue n % n % n % Only the severity of the defect is considered 0 0% 0 0% 4 8% 6.408 0.171 The severity of the defect, the child's age, the presence of symptoms, and the child's caries risk are considered 6 100 % 41 95% 47 92% Treatment plans are standardized for all cases 0 0% 2 5% 0 0% Total 6 100% 43 100% 51 100% Q7 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Good oral hygiene practices, fluoride treatments, and dental sealants are recommended 4 67% 31 73% 43 85% 3.920 0.417 No specific preventive measures are recommended 0 0% 4 9% 2 4% Preventive measures are not effective for MIH 2 33% 8 18% 6 12% Total 6 100% 43 100% 51 100% Q8 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Primarily fillings made of composite 0 0% 6 14% 6 12% 5.615 0.230 Resin infiltration, glass ionomer cement 2 33% 23 55% 33 65% Use of crowns and veneers 4 67% 14 32% 12 23% Total 6 100% 43 100% 51 100% Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Page145 Q9 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Fluoride varnish, sealants, and sometimes bleaching are considered 0 0% 25 59% 20 38% 11.715 0.020* Non-restorative options are rarely considered 2 33% 2 5% 10 19% Only fluoride varnish with remineralizing agents 4 67% 16 36% 22 42% Total 6 100% 43 100% 51 100% Q10 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Follow-up appointments are only scheduled for complex cases 0 0% 2 5% 4 8% 2.819 0.589 Follow-up appointments are typically scheduled every 6 months 6 100% 41 95% 45 88% No regular follow-up appointments are scheduled 0 0% 0 0% 2 4% Total 6 100% 43 100% 51 100% Q11 Other Pediatric Dentist Post Graduate Student ꭓ2 PValue n % n % n % Patient behavior, financial constraints, and limited access to specialized equipment or materials can be barriers 4 67% 27 64% 31 62% 0.08 6 0.958 The primary barrier is the lack of awareness among dentists 2 33% 16 36% 20 38% Total 6 100% 43 100% 51 100% Q12 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Immediate extraction of the affected 0 0% 0 0% 1 3% 4.545 0.337 Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 Page146 tooth Only traditional restorative fillings 2 33% 10 23% 20 39% Silver Diamine Fluoride (SDF) application 4 67% 33 77% 30 58% Total 6 100% 43 100% 51 100% Q13 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % It can be a minimally invasive option to strengthen and seal the affected enamel 2 33% 37 86% 45 88% 32.908 <0.001* It is contraindicated in MIH due to the weakened enamel structure 4 67% 6 14% 0 0% It is not effective in MIH-affected teeth 0 0% 0 0% 6 12% Total 6 100% 43 100% 51 100% Q14 Other Pediatric Dentist Post Graduate Student ꭓ2 PValue n % n % n % MIH-affected teeth often require more conservative and minimally invasive approaches 6 100% 29 68% 41 81% 6.115 0.191 MIH-affected teeth require more aggressive treatment 0 0% 12 27% 6 12% There are no significant differences in management 0 0% 2 5% 4 8% Total 6 100% 43 100% 51 100% Q15 Other Pediatric Dentist Post Graduate Student ꭓ2 PValue n % n % n % Avoiding all sugary foods and drinks 0 0% 0 0% 6 12% 16.276 0.003 * Regular dental check-ups and good oral hygiene practices at home 6 100% 35 82% 45 88% Relying solely on restorative treatments 0 0% 8 18% 0 0% Total 6 100% 43 100% 51 100% Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 Page147 *denotes significant association Q16 Other Pediatric Dentist Post Graduate Student n % n % n % To promote remineralization of weakened enamel 6 100% 11 26% 51 100% Total 6 100% 11 26% 51 100% Q17 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % By delivering calcium and phosphate ions to the tooth surface, facilitating remineralization 6 100% 39 91% 51 100% 5.393 0.249 By directly filling in the defects in the enamel 0 0% 2 5% 0 0% By strengthening the underlying dentin 0 0% 2 5% 0 0% Total 6 100% 43 100% 51 100% Q18 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % At bedtime, allowing for prolonged contact with the teeth 2 33% 37 86% 41 81% 44.791 <0.001* Before brushing in the morning 4 67% 2 5% 0 0% Immediately after brushing and flossing 0 0% 4 9% 10 19% Total 6 100% 43 100% 51 100% *denotes significant association Q19 Other Pediatric Dentist Post Graduate Student ꭓ2 P-Value n % n % n % Apply a thin layer to the affected teeth and avoid rinsing for at least 30 minutes 4 67% 39 91% 43 85% 2.841 0.242 Apply a thin layer to the affected teeth and rinse thoroughly 2 33% 4 9% 8 15% Total 6 100% 43 100% 51 100% Q20 Other Pediatric Dentist Post Graduate Student n % n % n % Composite 1 10% 4 10% 5 10% Extraction 1 20% 9 20% 10 20% Fluoride varnish 1 14% 6 14% 7 14% Glass ionomer cement 3 48% 21 48% 24 48% Not sure 0 8% 3 8% 4 8% Total 6 100% 43 100% 51 100% Dr Syeda Husna Noorein, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 Page148 With MIH being a globally alarming problem and developing countries need to deal with the majority of MIH burden 5, there is a great need to address any knowledge gaps in such countries. To the best of the authors’ knowledge, this is the first questionnaire to investigate the knowledge, perceptions, attitudes, and clinical experiences on MIH among pediatric dentists and postgraduates. We used an online questionnaire because it is more accurate, easier to use by participants, and increases the obtained response rate. The prevalence of MIH in India was estimated to be 10.0% (95% CI: 0.07, 0.12) with significantly high heterogeneity.6 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. with the results from this study the knowledge about the etiology seems to be multifactorial in nature. The present study reveals the barriers in management of MIH initial lesion is the limited access to the specialized material act as barrier. A B Skaare et al.2021, The clinician’s treatment of MIH varied. Difficulties achieving adequate local anaesthetic (71.4%) and the child’s behavioural problems (84.1%) were treatment barriers for the dentists. Schwen-dicke et al. 2018 8 MIH-affected teeth, 27.4% (23.5–31.7%) did or will require the need for treatment due to pain, sensitivity, or post-eruptive breakdown .According to treatment for a semi-erupted permanent molar with moderate MIH, post-eruptive fracture and sensitivity in the tooth in a seven-year-old patient . The results showed the higher end to the use of GIC cement (37%) and Fluoride varnish (33.7%), with about 18% not sure about the treatment plan among pediatric dentist. Similar study shows that the use of composite restoration significant along with the GIC restoration sawia Karkoutly et.al. In the present study, the most preferred dental material used by respondents was GIC restoration and resin infiltration. The findings were consistent with other studies but not in agreement with the results of Crombie et al and Lygidakis et al. reported a successful result of composite resin restoration after four years of placement on two or more surfaces of affected MIH molars. On the other hand, Mejare et al. and Kotsanos et al. found a considerable failure rate with composite resin and a need for additional retreatment. A good response rate is a strength of this study. However, it has drawbacks. Firstly, in questionnaires, most participants would select answers that they deem correct, rather than those truly reflect their practices and beliefs. Secondly this study did not specify the demographic data as participants were from all over the globe. Thirdly, most participants were below the age of 30 and had fewer than 5 years of practice. Hence, the results of this questionnaire should be generalized with caution. Conclusion The findings from this survey provide valuable insights into the awareness of MIH. Where the average knowledge on MIH was considered better among pediatric dentists when compared with the post graduates and least amongst the general dentists. The Respondents did perceive an increased incidence of MIH, and lack in diagnosis, which could be corrected with the help of various programs and them being updated about the advanced restorative options available in market. The recommended material of choice is RMGIC as the restoration with RMGIC have proved to be a good option, presenting greater longevity in a molar with minor structural defects and requiring repair or replacement in molars with larger structural defects. For