Child-reported outcomes for the aesthetic management of molar incisor hypomineralisation

Background Molar Incisor Hypomineralisation (MIH), with a global prevalence of 12-14%, is one of the most common developmental defects of enamel (DEE) to affect children. The condition is associated with considerable functional and aesthetic problems with visible incisor opacities potentially having a negative impact on children’s social interaction and self-esteem. This prospective clinical study is the first to evaluate the impact of minimally invasive dental treatments, aimed at improving the appearance of enamel opacities associated with MIH, on children’s oral health-related quality of life and overall well-being. Aim This study aimed to explore the relationships between socio-demographics, clinical status and oral health-related quality of life (OHRQoL) in children with MIH who received aesthetic treatment for their incisor opacities. Materials and methods This clinical study involved children, aged 7-16 years, referred to a UK Dental Hospital for management of permanent anterior teeth enamel opacities of reported cosmetic concern. Following ethical approval, participants completed a number of validated questionnaires, primarily the C-OHIP-SF19, Harter’s Self-Perception Profile for Children (SPPC) and the Friends and Family Test, prior to any intervention (T0). Treatment regimens included: microabrasion, resin infiltration (Icon™, DMG), tooth whitening, composite resin restoration or a combination of treatments. The recruitment, treatment and subsequent visits were conducted from June 2017 to October 2018. Children were reviewed after one (T1) and six (T2) months, completing the questionnaires each time. Clinical photos were taken at each time point. Change in children’s OHRQoL and self-concept at T0, T1 and T2 were analysed using the Friedman’s Two Way Analysis of Variance by Rank and Wilcoxon Signed Rank tests. Links between predictors, the socio-emotional wellbeing domain of C-OHIP-SF19 and children’s OHRQoL were assessed using structural equation modelling and were underpinned by a theoretical model of HRQoL proposed by Wilson and Cleary. Results Of 111 children initially invited, 103 consented to participate and 86 were reviewed at 6-months (83% completion rate). They had a mean age of 11-years (range 7-15), 60% were female and the majority (92%) were White British/Northern European. Most children (56%) received a combination of microabrasion and Icon™. Children were very positive about the treatment they had received (100% likely to recommend their care to friends and family). The total and all C-OHIP-SF19 domain scores were significantly increased following treatment, indicating substantial improvement in OHRQoL (p<0.001). In addition, there was a significant change in the SPPC, Physical Appearance subscale scores, reflecting children’s perceptions that they looked better following treatment (p<0.001). Within the Wilson and Cleary model, a higher number of anterior teeth requiring aesthetic treatment was linked to lower socio-emotional wellbeing scores at T2 (ß=-0.179, p<0.01). Greater need for orthodontic treatment at baseline was related to worse OHRQoL at T2 (ß=-0.154,p<0.05). Higher self-concept at baseline was significantly associated with higher OHRQoL and socio-emotional wellbeing at baseline (ß=0.460,p<0.01 and ß=0.254,p<0.05). Self-concept at baseline indirectly predicted socio-emotional wellbeing at six-months follow-up, via socio-emotional wellbeing at baseline (ß=0.197, p<0.01). Conclusions This is the first study to explore and demonstrate the simultaneous effects of clinical status, self-concept, socio-emotional wellbeing and children’s OHRQoL following simple aesthetic treatment for incisor opacities associated with MIH. Whilst minimal interventions for incisor opacities undoubtedly improve children’s OHRQoL, a number of complex psychosocial factors and clinical confounders may influence this overall outcome.