Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization


  • Heloisa Aparecida Orsini Vieira
  • Lisa Danielly Curcino Araújo
  • Fabrício Kitazono de Carvalho
  • Alexandra Mussolino de Queiroz
  • Francisco Wanderley Garcia Paula-Silva


Diagnosis, Education, Professional, Dental Enamel Hypoplasia, Calibration.


Objective: To evaluate an imaging protocol for use as a diagnostic and calibration tool for dentists before and after practical activity. Material and Methods: Thirty photos of children's teeth with or without changes in dental enamel were selected and evaluated by a group of experienced dentists previously calibrated to establish the diagnosis defined as the gold standard. After instructions, the images were shown to a group of postgraduate dentists for free identification of dental changes. Subsequently, a lecture on molar incisor hypomineralization (MIH) was carried out, and, at 14 days and all calibration was performed using the criteria previously. The retest was performed at 28 days. After experience in clinical activity in the following two weeks, the post-test was performed at 49 days.  Data were analyzed using Cohen's kappa coefficient. Results: Theoretical learning on the subject showed low inter-examiner agreement when the diagnosis of defects was made from images obtained from intraoral photographs. After clinical practice, there was greater intra-examiner agreement.  After theoretical training, dentists started to identify different types of enamel alteration, although with low agreement between them. Conclusion: Clinical experience in theoretical and imaging training favored the identification of defects. However, it is necessary to improve the protocol to establish a reliable and viable diagnostic method for calibration in MIH.


Weerheijm KL. Molar incisor hypomineralisation (MIH). Eur J Paediatr Dent 2003; 4(3):114-20.

Farah RA, Swain MV, Drummond BK, Cook R, Atieh M. Mineral density of hypomineralised enamel. J Dent 2010; 38(1):50-8.

Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent 2018; 28(2):170-9.

Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Corrigendum to "Global burden of molar incisor hypomineralization" [J. Dent. 68C (2018) 10-18]. J Dent 2019; 80:89-92.

Silva FMF, Zhou Y, Vieira FGF, Carvalho FM, Costa MC, Vieira AR. Defining the prevalence of molar incisor hypomineralization in Brazil. Pesqui Bras Odontopediatria Clín Integr 2020; 20:e5146.

Soviero V, Haubek D, Trindade C, Da Matta T, Poulsen S. Prevalence and distribution of demarcated opacities and their sequelae in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children. Acta Odontol Scand 2009; 67(3):170-5.

Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization – a systematic review. Community Dent Oral Epidemiol 2016; 44(4):342-53.

Vieira AR, Kup E. On the etiology of molar-incisor hypomineralization. Caries Res 2016; 50(2):166-9.

Bezamat M, Souza JF, Silva FMF, Corrêa EG, Fatturi AL, Brancher JA, et al. Gene-environment interaction in molar-incisor hypomineralization. PLoS One 2021; 16(1):e0241898.

Ghanim A, Elfrink M, Weerheijm K, Mariño R, Manton D. A practical method for use in epidemiological studies on enamel hypomineralisation. Eur Arch Paediatr Dent 2015; 16(3):235-46.

Elfrink MEC, Ghanim A, Manton DJ, Weerheijm KL. Standardised studies on molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM): a need. Eur Arch Paediatr Dent 2015; 16(3):247-55.

Garot E, Denis A, Delbos Y, Manton D, Silva M, Rouas P. Are hypomineralised lesions on second primary molars (HSPM) a predictive sign of molar incisor hypomineralisation (MIH)? a systematic review and a meta-analysis. J Dent 2018; 72:8-13.

Vlachou C, Arhakis A, Kotsanos N. Distribution and morphology of enamel hypomineralisation defects in second primary molars. Eur Arch Paediatr Dent 2021; 22(2):241-6.

Ministry of Health. Project SB2000: Oral Health Conditions of the Brazilian Population in the year 2000: Calibration Manual for Examiners. Brasília: Ministry of Health; 2001. 31p. [In Portuguese].

Peres MA, Traebert J, Marcenes W. Calibration of examiners for dental caries epidemiology studies. Cad Saúde Pública 2001; 17(1):153-9.

World Health Organization. Oral health surveys: basic methods. 5th. ed. Geneva: World Health Organization; 2013. 126p.

Jälevik B. Prevalence and diagnosis of molar-incisor-hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent 2010; 11(2):59-64.

Partido BB. Ergonomics calibration training utilizing photography for dental hygiene faculty members. J Dent Educ 2017; 81(10):1187-93.

Ghanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Mariño RJ, Weerheijm KL, et al. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent 2017; 18(4):225-42.

Garland KV, Newell KJ. Dental hygiene faculty calibration in the evaluation of calculus detection. J Dent Educ 2009; 73(3):383-9.

Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968; 70(4):213-20.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1):159-74.

Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 Countries, 1990-2015: A systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 2017; 96(4):380-7.

Jälevik B, Klingberg G. Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls - a longitudinal study. Int J Paediatr Dent 2012; 22(2):85-91.

Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. J Dent 2018; 68:10-18.

Portella PD, Menoncin BLV, de Souza JF, de Menezes JVNB, Fraiz FC, Assunção LRDS. Impact of molar incisor hypomineralization on quality of life in children with early mixed dentition: A hierarchical approach. Int J Paediatr Dent 2019; 29(4):496-506.

Rodd HD, Graham A, Tajmehr N, Timms L, Hasmun N. Molar incisor hypomineralisation: current knowledge and practice. Int Dent J 2021; 71(4):285-91.

Ghanim A, Mariño R, Manton DJ. Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index. Int J Paediatr Dent 2019; 29(1):6-13.

McHugh ML. Interrater reliability: the kappa statistic. Biochem Med 2012; 22(3):276-82.

Gambetta-Tessini K, Mariño R, Ghanim A, Calache H, Manton DJ. Knowledge, ex-perience and perceptions regarding Molar-Incisor Hypomineralisation (MIH) amongst Australian and Chilean public oral health care practitioners. BMC Oral Health 2016; 16(1):75.

Serna-Muñoz C, Martínez-Beneyto Y, Pérez-Silva A, Poza-Pascual A, Ibáñez-López FJ, Ortiz-Ruiz AJ. Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study. BMC Oral Health 2020; 20(1):260.

Craveia J, Rouas P, Carat T, Manton DJ, Boileau MJ, Garot E. Knowledge and management of first permanent molars with enamel hypomineralization among dentists and orthodontists. J Clin Pediatr Dent 2020; 44(1):20-7.

Wall A, Leith R. A questionnaire study on perception and clinical management of molar incisor hypomineralisation (MIH) by Irish dentists. Eur Arch Paediatr Dent 2020; 21(6):703-10.

Aguilar Gálvez D, Noal FC, Arriola-Guillén LE, Hugo FN, Leal SC, Araujo FB. Virtual learning object for developing knowledge about the diagnosis and management of molar incisor hypomineralization. Int J Paediatr Dent 2022; 32(4):458-63.




How to Cite

Vieira, H. A. O., Araújo, L. D. C., de Carvalho, F. K., de Queiroz, A. M., & Paula-Silva, F. W. G. (2023). Use of Images and Clinical Experience to Calibrate Dental Surgeons for the Diagnosis of Molar Incisor Hypomineralization. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 23, e220040. Retrieved from



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