Oral health-related quality of life and survival analysis after preventive and restorative treatment of molar-incisor hypomineralisation

Abstract

The aim of this study was to assess the impact of molar-incisor hypomineralisation (MIH) on oral health-related quality of life (OHRQoL) in children and adolescents, including information on restorative care, tooth sensitivity, as well as sociodemographic factors. Thirty-five patients aged between 7 and 17 years underwent a comprehensive oral examination. Severity of MIH was graded using the MIH Treatment Need Index (MIH-TNI), OHRQoL using the Child Oral Health Impact Profile (COHIP-19). Clinical quality of restorations was assessed according to modified FDI-criteria, tooth sensitivity using the Schiff Cold Air Sensitivity Scale (SCASS). The mean age was 11.3 ± 3.0 years, 34% were female. On average, 6.9 ± 2.8 teeth were affected, 62,9% had hypersensitive teeth (SCASS ≥ 1). Eighty-nine percent of patients had received restorative care, with a mean of 3.3 ± 2.1 teeth restored, most often with composite, followed by fissure sealing. Nine percent of restorations failed by the FDI-criteria. Mean estimated survival times for success were 4.9 years (95% CI 3.5; 6.2) and 5.6 years (95% CI 5.0; 6.3) for fissure sealants and composite restorations, respectively. The mean COHIP-19 score was 64.3 ± 8.2 (max. possible score = 76). A higher severity of MIH-TNI correlated significantly with impaired OHRQoL (r_s = - 0.38, p = 0.013). However, this was not mirrored in multiple regression analysis. Despite the high rate of restorative treatment with an acceptable failure rate, OHRQoL is reduced in children with MIH. Many teeth affected by MIH remain sensitive. Further studies are needed to assess the benefits of different restorative options.

Figure 1

Distribution of MIH-severity according to the MIH-TNI Index.

Figure 2

Examples of composite restorations on MIH-affected teeth. (A–C) Clinically acceptable composite restorations (clinically very good—clinically acceptable depending on the domains of the modified FDI criteria); (A) lower left first molar, follow-up 1.5 years; (B) upper right first molar, follow-up 7 years; (C) upper LEFT first molar, follow-up 7 years; (D–F) clinically inacceptable composite restorations (clinically unsatisfactory); (D) lower right first molar, follow-up 4 years, unsatisfactory marginal adaptation; (E) lower left first molar, follow-up 4.5 years, unsatisfactory marginal adaptation and presence of caries at restoration margin; (F) lower left first molar, follow-up 4 years, unsatisfactory marginal adaptation and presence of caries at restoration margin.

Figure 3

Kaplan–Meier survival curve of 27 fissure sealings and 67 composite restorations on teeth affected by MIH (A) complete success (B) including success with repair.