Background: Molar–incisor hypomineralization (MIH) is an enamel defect affecting molars and incisors, often leading to hypersensitivity, enamel breakdown, and increased caries risk. Non-invasive treatments, such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and fluoride varnish, show potential in remineralizing affected enamel and reducing sensitivity, but their efficacy is still debated. This study systematically reviews and analyzes the effectiveness of CPP-ACP and other non-invasive agents in improving remineralization and reducing hypersensitivity in MIH-affected teeth. Methods: A systematic search was conducted on PubMed, Embase, and Central in July 2024, including interventional and observational studies on remineralization and hypersensitivity in pediatric MIH patients (<18 years). A total of 1566 studies were found, with 15 included in the meta-analysis. A random-effects model was applied, including subgroup analysis by lesion severity. Results: CPP-ACP showed no statistically significant advantage over fluoride in remineralization (MD −3.80, 95% CI: −8.57; 0.98), but it significantly reduced hypersensitivity compared to fluoride varnish (MD −2.36, 95% CI: −3.83; −0.89). Although this reduction in hypersensitivity may be clinically relevant, the high heterogeneity (I² = 83%) and wide confidence intervals limit the reliability of these findings. Conclusions: CPP-ACP has a moderate effect in reducing hypersensitivity but does not outperform fluoride in remineralization. Other agents, such as calcium glycerophosphate and silver diamine fluoride, showed mild benefits. The current evidence base is limited and heterogeneous, highlighting the need for high-quality, long-term studies to confirm these findings and guide MIH management.

Human dental enamel is a uniquely hard and tough biological realization of the inherently brittle apatite crystal. In sound enamel both structure and chemistry are organically fine-tuned, while developmental disorders - such as hypomineralization - often lead to severe enamel alterations resulting in weaker mechanical performance and shorter lifetime as in case of molar-incisor hypomineralization (MIH) which has a global prevalence of 13.5%. However, causes of the development of hypomineralization disorder remain unclear up to date. In the present paper, a new form of dental hypomineralization is reported for the first time. Structural and chemical alterations of dental enamel exhibiting a special ribbon-like hypomineralization (RLH) are compared to the characteristics of sound and MIH-affected teeth. Microporosity, mineral density and characteristic 3D macroscopic shape of the RLH affected volumes were captured by micro-CT analysis. On the submicron-scale, nanoporosity, unusual morphologies and reduced size of apatite nanocrystals have been revealed. These RLH specific features are coupled with a particular chemical fingerprint in Raman spectroscopy, which allows its clear separation from MIH affected and sound enamel. Based on these nanostructural features we conclude different failure mechanisms in the biochemical control during crystallization of the RLH and MIH enamel. STATEMENT OF SIGNIFICANCE: Molar-incisor hypomineralization (MIH) is a developmental enamel disorder with up to 14% prevalence, characterized by reduced mineral content, hypersensitivity, and post-eruptive enamel breakdown. The causes of the development of this disorder remain unclear up to date. In this study, we examine molars with hypomineralization in a ribbon-like macroscopic morphology. These molars show increased porosity, organic content, and reduced mineral content, while carbonate levels remain unchanged in both affected and unaffected areas, unlike MIH-affected enamel. Ribbon-like hypomineralized (RLH) enamel also features unusual apatite nanocrystal morphologies, including isometric crystals in the prism boundary zone and bean-shaped crystals with a soft central zone. Nanoscale analysis reveals RLH as a developmental anomaly distinct from MIH, offering novel insights into the biochemical controls of hypomineralization.

Molar Incisor Hypomineralization (MIH) is a developmental enamel defect affecting one in six children worldwide. Although antibiotics have been suggested to influence dental development, their association with MIH remains unclear. This systematic review and meta-analysis evaluated the association between early childhood antibiotic exposure and the risk of developing MIH. MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to December 17, 2024. Observational studies (cross-sectional, case-control) including children aged 6-14 years diagnosed with MIH using validated criteria were eligible. Exposure was defined as antibiotic use before age 4. Studies involving special populations or other enamel defects were excluded. Risk of bias was assessed using the QUIPS tool. A random-effects model calculated odds ratios (ORs) and 95% confidence intervals (CIs). From 3308 records, 41 studies met the criteria and 31 were included in the meta-analysis, with 22,141 participants aged 6-14. Antibiotic use before age 4 was significantly associated with MIH (OR:1.50, 95% CI 1.13 - 1.99, p = 0.0070). Amoxicillin (OR: 1.87; 95% CI: 0.83-4.21, p = 0.104) and penicillin (OR: 2.15; 95% CI: 0.73-6.34, p = 0.130) resulted in higher odds for the development of MIH. Early antibiotic use before age 4 is associated with higher odds of developing MIH. However, given the low certainty of evidence, this finding should be interpreted with caution, as it remains unclear whether the link is direct or indirect, highlighting the need for further research to guide prevention strategies. MIH poses diagnostic and treatment challenges. Contributing factors must be identified judiciously. Prudent antibiotic use should be integrated into clinical practice to reduce potential risk and promote better long-term oral health in children.

Although preventable oral diseases are still very common among school-aged children worldwide, dental caries remains a significant public health concern despite decades of school-based prevention approaches. Oral hygiene habits formed during childhood are essential to long-term oral and general health. This study assessed how well various school-based oral health education strategies improved kids’ oral hygiene, during the education and in long term. Controlled interventional studies involving healthy children in school settings were used in a quantitative systematic review and meta-analysis. Teachers, dental professionals, or other educational methods were used to deliver the educational programs. Standardized oral hygiene indices were used to compare the non-educated control groups before and after the intervention. Artificial intelligence–assisted screening was used to improve the efficiency and consistency of the study selection process. While alternative educational approaches showed more limited effects, teacher-led and health care worker–led interventions were linked to significant short-term improvements in oral hygiene. However, over longer follow-up periods, improvements were not consistently maintained. These results show how crucial schools are as venues for promoting oral health, but they also suggest that traditional education-focused interventions might not be enough to bring about long-lasting behavioral change. To achieve long-lasting population-level oral health benefits, program design, implementation, and integration into larger health promotion strategies may need to be strengthened.