THE IMPACT OF DEVELOPMENTAL ENAMEL DEFECTS ON QUALITY OF LIFE AND PSYCHOSOCIAL ASPECTS IN MINOR PATIENTS WITH MIH, AMELOGENESIS IMPERFECTA, AND DENTAL FLUOROSIS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5850Keywords:
Developmental Enamel Defects, MIH, Fluorosis, Amelogenesis Imperfecta, OHRQoL, Pediatric DentistryAbstract
Developmental enamel defects (DEDs) constitute a clinically significant group of conditions with multifactorial etiology. Beyond their structural and functional consequences — including dentinal hypersensitivity, increased susceptibility to caries, and mechanical fragility — developmental enamel defects significantly reduce oral health-related quality of life (OHRQoL) in the pediatric population.
The aim of this literature review was to characterize three distinct developmental enamel defects — molar-incisor hypomineralization (MIH), dental fluorosis, and amelogenesis imperfecta (AI) — and to evaluate their impact on OHRQoL in minor patients.
Between March and May 2026, the PubMed and Google Scholar databases were searched, with inclusion limited to English-language publications.
All three conditions were associated with reduced OHRQoL through aesthetic compromise, diminished self-esteem, and social avoidance. In MIH, patients face difficulties achieving effective anesthesia and demonstrate a pronounced tendency toward carious lesions. Fluorosis negatively affects self-perception among those affected. AI is associated with psychological distress and social withdrawal. Prosthetic rehabilitation and aesthetic treatment improve OHRQoL in patients with developmental enamel defects. Aesthetic dental treatment in this group should be regarded as a preventive intervention against depression and social exclusion, rather than merely a cosmetic procedure.
References
Lopes, C. M. M. T., Falcão, L. J. S., Lemos, L. M., Costa, L. L., & Santos, P. B. (2026). Prevalence of developmental defects of enamel in Brazil: A systematic review and meta-analysis. European Archives of Paediatric Dentistry. Advance online publication. https://doi.org/10.1007/s40368-026-01193-z
Seow, W. K. (2014). Developmental defects of enamel and dentine: Challenges for basic science research and clinical management. Australian Dental Journal, 59(Suppl. 1), 143–154. https://doi.org/10.1111/adj.12104
Papio, M. A., Fields, H. W., Jr., Beck, F. M., Firestone, A. R., & Rosenstiel, S. F. (2019). The effect of dental and background facial attractiveness on facial attractiveness and perceived integrity and social and intellectual qualities. American Journal of Orthodontics and Dentofacial Orthopedics, 156(4), 464–474.e1. https://doi.org/10.1016/j.ajodo.2018.10.021
Larsson, P., Bondemark, L., & Häggman-Henrikson, B. (2021). The impact of oro-facial appearance on oral health-related quality of life: A systematic review. Journal of Oral Rehabilitation, 48(3), 271–281. https://doi.org/10.1111/joor.12965
John, M. T., Hujoel, P., Miglioretti, D. L., LeResche, L., Koepsell, T. D., & Micheelis, W. (2004). Dimensions of oral-health-related quality of life. Journal of Dental Research, 83(12), 956–960. https://doi.org/10.1177/154405910408301213
Inchingolo, A. M., Inchingolo, A. D., Viapiano, F., Ciocia, A. M., Ferrara, I., Netti, A., Dipalma, G., Palermo, A., & Inchingolo, F. (2023). Treatment approaches to molar incisor hypomineralization: A systematic review. Journal of Clinical Medicine, 12(22), 7194. https://doi.org/10.3390/jcm12227194
Dulla, J. A., & Meyer-Lueckel, H. (2021). Molar-incisor hypomineralisation: Narrative review on etiology, epidemiology, diagnostics and treatment decision. Swiss Dental Journal, 131(11), 886–895. https://doi.org/10.61872/sdj-2021-11-763
Guerra, F., Mazur, M., Corridore, D., Pasqualotto, D., Nardi, G. M., & Ottolenghi, L. (2015). Evaluation of the esthetic properties of developmental defects of enamel: A spectrophotometric clinical study. The Scientific World Journal, 2015, 878235. https://doi.org/10.1155/2015/878235
Lygidakis, N. A., Garot, E., Somani, C., Taylor, G. D., Rouas, P., & Wong, F. S. L. (2022). Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): An updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry, 23(1), 3–21. https://doi.org/10.1007/s40368-021-00668-5
Weerheijm, K. L., & Mejàre, I. (2003). Molar incisor hypomineralization: A questionnaire inventory of its occurrence in member countries of the European Academy of Paediatric Dentistry (EAPD). International Journal of Paediatric Dentistry, 13(6), 411–416. https://doi.org/10.1046/j.1365-263x.2003.00498.x
Dave, M., & Taylor, G. (2018). Global prevalence of molar incisor hypomineralisation. Evidence-Based Dentistry, 19(3), 78–79. https://doi.org/10.1038/sj.ebd.6401324
Schwendicke, F., Elhennawy, K., Reda, S., Bekes, K., Manton, D. J., & Krois, J. (2018). Global burden of molar incisor hypomineralization. Journal of Dentistry, 68, 10–18. https://doi.org/10.1016/j.jdent.2017.12.002
Garot, E., Denis, A., Delbos, Y., Manton, D., Silva, M., & Rouas, P. (2018). Are hypomineralised lesions on second primary molars (HSPM) a predictive sign of molar incisor hypomineralisation (MIH)? A systematic review and a meta-analysis. Journal of Dentistry, 72, 8–13. https://doi.org/10.1016/j.jdent.2018.03.005
Altan, H., & Yilmaz, R. E. (2023). Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces. BMC Oral Health, 23(1), 444. https://doi.org/10.1186/s12903-023-03140-6
Somani, C., Taylor, G. D., Garot, E., Rouas, P., Lygidakis, N. A., & Wong, F. S. L. (2022). An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): A systematic review. European Archives of Paediatric Dentistry, 23(1), 39–64. https://doi.org/10.1007/s40368-021-00635-0
Özbey İpek, H., & Bolaca, A. (2025). Evaluation of dental fear and dental caries in pediatric patients with molar incisor hypomineralization. Oral Health & Preventive Dentistry, 23, 629–634. https://doi.org/10.3290/j.ohpd.c_2316
Dantas-Neta, N. B., Moura, L. F., Cruz, P. F., Moura, M. S., Paiva, S. M., Martins, C. C., & Lima, M. D. (2016). Impact of molar-incisor hypomineralization on oral health-related quality of life in schoolchildren. Brazilian Oral Research, 30(1), e117. https://doi.org/10.1590/1807-3107BOR-2016.vol30.0117
Sardenberg, F., Martins, M. T., Bendo, C. B., Pordeus, I. A., Paiva, S. M., Auad, S. M., & Vale, M. P. (2013). Malocclusion and oral health-related quality of life in Brazilian school children. The Angle Orthodontist, 83(1), 83–89. https://doi.org/10.2319/010912-20.1
Michaelis, L., Ebel, M., Bekes, K., Klode, C., & Hirsch, C. (2021). Influence of caries and molar incisor hypomineralization on oral health-related quality of life in children. Clinical Oral Investigations, 25(9), 5205–5216. https://doi.org/10.1007/s00784-021-03828-5
Olczak-Kowalczyk, D., et al. (2023). Kompendium stomatologii wieku rozwojowego (pp. 112–115). Med Tour Press.
DenBesten, P. K. (1999). Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements. Community Dentistry and Oral Epidemiology, 27(1), 41–47. https://doi.org/10.1111/j.1600-0528.1999.tb01990.x
Akosu, T. J., & Zoakah, A. I. (2008). Risk factors associated with dental fluorosis in Central Plateau State, Nigeria. Community Dentistry and Oral Epidemiology, 36(2), 144–148. https://doi.org/10.1111/j.1600-0528.2007.00387.x
Khan, D., Mattia, A., Wang, Z., & Malin, A. J. (2025). Urinary fluoride and dental fluorosis in relation to kidney and liver function in adolescents and young adults in the United States. Environmental Health, 24(1), 85. https://doi.org/10.1186/s12940-025-01235-x
Abanto Alvarez, J., Rezende, K. M., Marocho, S. M., Alves, F. B., Celiberti, P., & Ciamponi, A. L. (2009). Dental fluorosis: Exposure, prevention and management. Medicina Oral, Patología Oral y Cirugía Bucal, 14(2), E103–E107. http://www.medicinaoral.com/pubmed/medoralv14_i2_pE103.pdf
Aoba, T., & Fejerskov, O. (2002). Dental fluorosis: Chemistry and biology. Critical Reviews in Oral Biology and Medicine, 13(2), 155–170. https://doi.org/10.1177/154411130201300206
Zotti, F., Albertini, L., Tomizioli, N., Capocasale, G., & Albanese, M. (2020). Resin infiltration in dental fluorosis treatment—1-year follow-up. Medicina, 57(1), 22. https://doi.org/10.3390/medicina57010022
Den Besten, P. K. (1994). Dental fluorosis: Its use as a biomarker. Advances in Dental Research, 8(1), 105–110. https://doi.org/10.1177/08959374940080010201
Hassebrauck, M. (1998). The visual process method: A new method to study physical attractiveness. Evolution and Human Behavior, 19(2), 111–123. https://doi.org/10.1016/S1090-5138(98)00002-6
Marshman, Z., Gibson, B., & Robinson, P. G. (2009). The impact of developmental defects of enamel on young people in the UK. Community Dentistry and Oral Epidemiology, 37(1), 45–57. https://doi.org/10.1111/j.1600-0528.2008.00453.x
Molina-Frechero, N., Nevarez-Rascón, M., Nevarez-Rascón, A., González-González, R., Irigoyen-Camacho, M. E., Sánchez-Pérez, L., López-Verdin, S., & Bologna-Molina, R. (2017). Impact of dental fluorosis, socioeconomic status and self-perception in adolescents exposed to a high level of fluoride in water. International Journal of Environmental Research and Public Health, 14(1), 73. https://doi.org/10.3390/ijerph14010073
García-Pérez, Á., Irigoyen-Camacho, M. E., Borges-Yáñez, S. A., Zepeda-Zepeda, M. A., Bolona-Gallardo, I., & Maupomé, G. (2017). Impact of caries and dental fluorosis on oral health-related quality of life: A cross-sectional study in schoolchildren receiving water naturally fluoridated at above-optimal levels. Clinical Oral Investigations, 21(9), 2771–2780. https://doi.org/10.1007/s00784-017-2079-1
Siddiq, H., Pentapati, K. C., & Acharya, S. (2020). Children’s perception of other children with dental fluorosis—A cross-sectional study. Journal of Oral Biology and Craniofacial Research, 10(2), 72–77. https://doi.org/10.1016/j.jobcr.2020.02.005
Witkop, C. J. (1957). Hereditary defects in enamel and dentin. Acta Genetica et Statistica Medica, 7(1), 236–239. https://doi.org/10.1159/000150974
Bäckman, B., & Holm, A. K. (1986). Amelogenesis imperfecta: Prevalence and incidence in a northern Swedish county. Community Dentistry and Oral Epidemiology, 14(1), 43–47. https://doi.org/10.1111/j.1600-0528.1986.tb01493.x
Bloch-Zupan, A., Rey, T., Jimenez-Armijo, A., Kawczynski, M., Kharouf, N., O-Rare Consortium, Dure-Molla, M., Noirrit, E., Hernandez, M., Joseph-Beaudin, C., Lopez, S., Tardieu, C., Thivichon-Prince, B., ERN Cranio Consortium, Dostalova, T., Macek, M., Jr., International Consortium, Alloussi, M. E., Qebibo, L., Morkmued, S., … Laugel-Haushalter, V. (2023). Amelogenesis imperfecta: Next-generation sequencing sheds light on Witkop’s classification. Frontiers in Physiology, 14, 1130175. https://doi.org/10.3389/fphys.2023.1130175
Witkop, C. J., Jr. (1988). Amelogenesis imperfecta, dentinogenesis imperfecta and dentin dysplasia revisited: Problems in classification. Journal of Oral Pathology, 17(9–10), 547–553. https://doi.org/10.1111/j.1600-0714.1988.tb01332.x
Crawford, P. J., Aldred, M., & Bloch-Zupan, A. (2007). Amelogenesis imperfecta. Orphanet Journal of Rare Diseases, 2, 17. https://doi.org/10.1186/1750-1172-2-17
Aren, G., Ozdemir, D., Firatli, S., Uygur, C., Sepet, E., & Firatli, E. (2003). Evaluation of oral and systemic manifestations in an amelogenesis imperfecta population. Journal of Dentistry, 31(8), 585–591. https://doi.org/10.1016/S0300-5712(03)00116-7
Hunter, L., Addy, L. D., Knox, J., & Drage, N. (2007). Is amelogenesis imperfecta an indication for renal examination? International Journal of Paediatric Dentistry, 17(1), 62–65. https://doi.org/10.1111/j.1365-263X.2006.00782.x
Pousette Lundgren, G., & Dahllöf, G. (2024). Advances in clinical diagnosis and management of amelogenesis imperfecta in children and adolescents. Journal of Dentistry, 147, 105149. https://doi.org/10.1016/j.jdent.2024.105149
Aldred, M., Crawford, P. J., Savarirayan, R., & Savulescu, J. (2003). It’s only teeth—Are there limits to genetic testing? Clinical Genetics, 63(5), 333–339. https://doi.org/10.1034/j.1399-0004.2003.00045.x
Pousette Lundgren, G., Karsten, A., & Dahllöf, G. (2015). Oral health-related quality of life before and after crown therapy in young patients with amelogenesis imperfecta. Health and Quality of Life Outcomes, 13, 197. https://doi.org/10.1186/s12955-015-0393-3
Coffield, K. D., Phillips, C., Brady, M., Roberts, M. W., Strauss, R. P., & Wright, J. T. (2005). The psychosocial impact of developmental dental defects in people with hereditary amelogenesis imperfecta. Journal of the American Dental Association, 136(5), 620–630. https://doi.org/10.14219/jada.archive.2005.0233
Sischo, L., & Broder, H. L. (2011). Oral health-related quality of life: What, why, how, and future implications. Journal of Dental Research, 90(11), 1264–1270. https://doi.org/10.1177/0022034511399918
Lferde, M., & Ramdi, H. (2025). Aesthetic management of molar-incisor hypomineralization with deep resin infiltration: A case report. Cureus, 17(6), e85800. https://doi.org/10.7759/cureus.85800
Idon, P. I., Ikusika, O. F., Sotunde, O. A., & Ogundare, T. O. (2022). Are there associations between the occurrence of dental fluorosis and the experience of dentine hypersensitivity? A cross-sectional study. The Nigerian Postgraduate Medical Journal, 29(2), 161–166. https://doi.org/10.4103/npmj.npmj_7_22
Heller, K. E., Eklund, S. A., & Burt, B. A. (1997). Dental caries and dental fluorosis at varying water fluoride concentrations. Journal of Public Health Dentistry, 57(3), 136–143. https://doi.org/10.1111/j.1752-7325.1997.tb02964.x
Jälevik, B., Sabel, N., & Robertson, A. (2022). Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents? A systematic review. European Archives of Paediatric Dentistry, 23(1), 65–78. https://doi.org/10.1007/s40368-021-00631-4
Appelstrand, S. B., Robertson, A., & Sabel, N. (2022). Patient-reported outcome measures in individuals with amelogenesis imperfecta: A systematic review. European Archives of Paediatric Dentistry, 23(6), 885–895. https://doi.org/10.1007/s40368-022-00737-3
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