The dental and orthodontic features, baseline anxiety and quality of life of children referred to a specialised centre for management of first permanent molars with Molar Incisor Hypomineralisation (MIH) or Caries

INTRODUCTION: Children may present with first permanent molars (FPM) affected by Molar Incisor Hypomineralisation (MIH), Caries, or other dental defects. AIMS: To describe the dental and orthodontic features, dental anxiety and oral-health-related quality-of-life (OHR-QoL) of children requiring management of FPM. To identify the factors clinicians consider when deciding on management of poor-quality FPM. METHODS: A descriptive observational study, prospectively recruited 105 children aged 6-12 referred for management of FPM affected by MIH(n=82), Caries(n=20), and Amelogenesis Imperfecta(n=3). Demographics, baseline dental anxiety and OHR-QoL using self-reported questionnaires (MCDASf, COHIP-SF19), clinical records (photographs, OPT radiographs, study models), and clinicians’ clinical assessment and treatment-planning were explored. Through a web-based survey, factors influencing clinicians’ planning of children with compromised FPM were investigated. RESULTS: There was no difference in anxiety scores between MIH-group and Caries-group children; although MIH children were more anxious of ‘having a filling’. Caries children had poorer OHR-QoL. There were no differences in orthodontic treatment need between Caries and MIH children, although Caries children had significantly more dental crowding. Each category of FPM management plan was significantly associated with: 1) Extraction: Caries-group children; lower second permanent molar (SPM) bifurcation (stage E); Frankl behaviour (-); poor oral-hygiene rating; class I skeletal pattern; deviant trait crowding. 2) Restoration: skeletal Class II. 3) Temporisation/review: younger chronological age (7.8); younger dental age (7.7); earlier developmental stage of lower SPM (stage D). 4) 15.0% of children had elective FPM extractions, and Caries-group children had significantly increased proportions. Mode of treatment was significantly associated with: 1) GA: Caries-group children; poor oral-hygiene rating; Frankl behaviour (+) or (-); elective FPM extractions. 2) LA: Frankl behaviour (++). The reasons most commonly considered by paediatric dental clinicians when treatment planning for children with poor-quality FPM were: patient behaviour/cooperation(75.6%), FPM restorability(70.7%), and presence/absence of developing teeth(68.8%). CONCLUSION: Many variables were associated with the planning of children with poor-quality FPM.