Knowledge, attitudes, and beliefs regarding molar incisor hypomineralization (MIH) amongst
German dental students
Elhennawy, Karim; Anang, Mostafa; Splieth, Christian; Bekes, Katrin; Manton, David John;
Hedar, Zen; Krois, Joachim; Jost-Brinkmann, Paul-Georg; Schwendicke, Falk
Published in:
International Journal of Paediatric Dentistry
DOI:
10.1111/ipd.12715
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Publication date: 2021
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Citation for published version (APA):
Elhennawy, K., Anang, M., Splieth, C., Bekes, K., Manton, D. J., Hedar, Z., Krois, J., Jost-Brinkmann, P-G., & Schwendicke, F. (2021). Knowledge, attitudes, and beliefs regarding molar incisor hypomineralization (MIH) amongst German dental students. International Journal of Paediatric Dentistry, 31(4), 486-495. https://doi.org/10.1111/ipd.12715
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Int J Paediatr Dent. 2020;00:1–10. wileyonlinelibrary.com/journal/ipd
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1 Received: 30 April 2020|
Revised: 30 June 2020|
Accepted: 20 July 2020DOI: 10.1111/ipd.12715
O R I G I N A L A R T I C L E
Knowledge, attitudes, and beliefs regarding molar incisor
hypomineralization (MIH) amongst German dental students
Karim Elhennawy
1|
Mostafa Anang
2|
Christian Splieth
2|
Katrin Bekes
3|
David John Manton
|
Zen Hedar
1|
Joachim Krois
5|
Paul-Georg Jost-Brinkmann
1|
Falk Schwendicke
5This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2020 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd 1Department of Orthodontics, Dentofacial
Orthopedics and Pedodontics, Charité – Universitätsmedizin Berlin, corporate memberof Freie Universität Berlin, Humboldt-Universität, and BerlinInstitute of Health, Aßmannshauser Str. 4-6, Berlin, 14197, Germany
2Department of Preventive and Paediatric
Dentistry, University of Greifswald, Greifswald, Germany
3Department of Paediatric Dentistry, School
of Dentistry, Medical University of Vienna, Vienna, Austria
4Paediatric Dentistry and Cariology,
Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, A. Deusinglaan 1, Groningen, 9700 AD, The Netherlands
5Department of Operative and Preventive
Dentistry, Charité – Universitätsmedizin Berlin, corporate memberof Freie Universität Berlin,
Humboldt-Universität, and BerlinInstitute of Health, Aßmannshauser Str. 4-6, Berlin, 14197, Germany
Correspondence
Karim Elhennawy, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin,
Humboldt-Universität, and BerlinInstitute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
Email: Karim.elhennawy@charite.de
Abstract
Background: Knowledge of molar incisor hypomineralization (MIH) has relevance
for paediatric dentists.
Aim: To assess final-year German dental students’ knowledge, attitudes, and beliefs
regarding MIH.
Materials and methods: A previously validated questionnaire was posted to the
31 German dental schools. Demographic covariates as well as knowledge regarding diagnosis and prevalence, and attitudes and beliefs around aetiology and manage-ment were collected.
Results: Twenty-two (71%) dental schools responded and a total of 877 students
par-ticipated. Most (97%) were familiar with MIH and 88% were aware of the diagnostic criteria for MIH; however, only 42% knew how to implement them. One-third were able to identify MIH and 16% reported diagnostic confidence when doing so; 90% assumed the MIH prevalence to be <10%. Two-thirds of the respondents implicated genetic components as the main aetiological factor of MIH. Resin composite (60%) and preformed metal crowns (46%) were the dental materials most often suggested for restorative management. Almost all (98%) respondents were interested in receiv-ing more clinical trainreceiv-ing.
Conclusion: German students were familiar with MIH; however, they reported
low levels of knowledge and confidence regarding its prevalence and diagnosis. Standardized nationwide, up-to-date curricula should be implemented to educate fu-ture dentists in Germany.
K E Y W O R D S
1
|
INTRODUCTION
Weerheijm and colleagues (2001) were the first to propagate the term Molar Incisor Hypomineralization (MIH),1 now
de-fined as ‘qualitative, demarcated developmental hypomineral-ized defects of one or more first permanent molar (FPM), with or without the involvement of the incisors’.2 The prevalence of
MIH ranges between 2% and 40% worldwide, with a global mean (95% CI) of 13.1% (11.8%-14.5%).3 It is likely that such
variance is mainly grounded in epidemiological methods of dif-ferent surveys rather than social, environmental, or geographic risk factors.3,4 Several aetiological pathways for MIH have been
discussed, with factors such as maternal smoking, illness during pregnancy (especially in the last trimester), premature or pro-longed birth, low birth weight and/or birth complications, child-hood illness (in the first year of life) and others like vitamin D deficiency and Bisphenol A being considered. However, the most probable explanation is multifactorial pathogenesis with a putative genetic component.5-8
Less distinct prism sheaths, disorganized enamel crystal arrangement, reduced mechanical properties, increased pro-tein content, and decreased mineral density are histologic, morphologic, and mechanical aspects that differentiate MIH-affected enamel from sound enamel.9 The clinical
appear-ance of MIH involves a wide spectrum varying from creamy/ white through yellow to brown colour changes with or without enamel post-eruptive breakdown (PEB).10,11 The presence of
hypersensitivity or involvement of the incisors may also have a negative effect on the child's oral health-related quality of life.12-14 Different authors have proposed different
classifica-tions for the severity of MIH,15-17 for example, according to
the appearance of the lesion as mild versus severe16 or mild
versus moderate versus severe,15 or furthermore,
consider-ing the hypersensitivity of a tooth in a more complex stagconsider-ing framework.17
MIH lays a significant burden on patients and their care-givers and potentially ‘the State’ due to its high prevalence. Furthermore, it is also challenging for most practitioners.11,18,19
Diagnosis, staging, and managing MIH appropriately are not skills at the command of the majority of dentists worldwide.20-23
Curricular education at dental schools and universities should address this deficiency; given that MIH has been in focus for over a decade now, it could be expected that current dental stu-dents are knowledgeable on this matter. There are extremely sparse data on dental students’ knowledge on MIH, and the only study indexed in PubMed, assessing a small sample of students from a single dental school in Saudi Arabia, found the students’ knowledge to be insufficient.24
We aimed to assess German dental students’ knowledge, attitudes, and beliefs towards MIH using a representative na-tionwide survey. The results of this study may be relevant in curriculum planning, for example in Germany, where the
national undergraduate dental curriculum is to be completely overhauled for the first time in over 60 years.25
2
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MATERIALS AND METHODS
2.1
|
Study design
A nationwide survey of final-year dental students in Germany was conducted. An existing questionnaire22,27 was validated
in German and used to assess German dental students’ knowledge, attitudes, and beliefs towards MIH. Reporting follows the STROBE checklist.26 This study was approved
by the ethics committee of Charité - Universitätsmedizin Berlin (EA2/214/17).
2.2
|
Setting, participants, sample size
A comprehensive nationwide sample of final-year students (at-tending 9th or 10th semester) from all dental schools in Germany was established. No formal sample size calculation was required or conducted. All dental schools (30 public universities, 1 private university) in Germany were invited via e-mail by the first and last author jointly, usually addressing the head of the paediatric dentistry department or unit in each school. An e-mail reminder was sent after four weeks. After approval, each university re-ceived their requested number of printed questionnaires and was asked to return the anonymously answered questionnaires.
2.3
|
Data sources and variables
Data were collected between January and December 2019. Similar questionnaires have been published previ-ously.20,23,24,28 The questionnaire started with a brief
descrip-tion of MIH, including clinical photographs, followed by item batteries on demographic data (age, gender, students’
Why this paper is important to paediatric dentists
• The foundation for MIH knowledge, attitudes, and beliefs is mainly laid during dental education. • The present results identify educational
accom-plishments, but also shed light on knowledge gaps that need to be addressed.
• The results of this study call for the implemen-tation of more in-depth and practical training on MIH in (under)graduate training.
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3ELHENNAWY EtAL.
semester), and concluded with questions on knowledge, at-titudes, and beliefs towards MIH (the condition's diagnosis and clinical presentation as well as prevalence, attitudes and beliefs towards management and educational needs).
A German native speaker translated the original English questions into German. Validation was performed via back-translation into English by another independent, English native speaker. The final questionnaire was piloted amongst faculty and 3rd-year dental students at Charité - Universitätsmedizin Berlin, ensuring that it had a valid set of questions, was easy to understand and could be completed within a reasonable period of time. After evaluating the re-sponses, the questionnaire was considered appropriate to be used unmodified (the full questionnaire is available from the authors). To estimate the intra-rater reliability, 3rd-year dental students were asked to answer the questionnaire again after one month. Intra-rater reliability was good (κ = 0.78).
2.4
|
Statistical analysis
Data were organized in a spreadsheet (Excel for Mac, Microsoft Corp., WA, USA). Data were controlled for normal distribution using the Shapiro-Wilk test and de-scriptive analyses performed accordingly. Statistical com-parison of groups (9th semester and 10th semester) was performed using independent samples t test or chi-square test. Missing values were excluded from the analysis. Statistical significance was assumed if P < .05. For sta-tistical analysis and geographic display, Python 3.6 and its scientific stack (eg, scipy, numpy, pandas, geopandas, matplotlib) were used. Statistical sub-grouping between public and private dental schools is advisable in this type of study, however, there is only one private dental school in Germany, and therefore we did not include such a sub-group for analysis.
FIGURE 1 The geographic distribution
of respondents at different universities. The size of the circle corresponds to the number of respondents (in parentheses: percentage of all responses)
TABLE 1 Students’ responses on knowledge, attitudes and believes towards MIH diagnosis and prevalence
Question Total response rate
Percentage distribution of positive answers All students 9th Semester 10th Semester Are you familiar with MIH?
97% 823 (97%) 472 (95%) 351 (99%)
How did you hear about it?
Dental journals 98% 215 (25%) 130 (26%) 85 (24%) Lectures 99% 748 (86%) 436 (86%) 312 (86%) Lecture notes 98% 226 (26%) 129 (26%) 97 (27%) Brochures or pamphlets 97% 32 (4%) 21 (4%) 11 (3%) Internet 98% 275 (32%) 154 (31%) 121 (34%) Books 98% 178 (21%) 92 (18%) 86 (24%) Dental clinic 98% 459 (53%) 266 (53%) 193 (54%) Other students 97% 61 (7%) 35 (7%) 26 (7%) Others 6%
Media (newspaper, magazines, TV, Internet) 17 (34%) 11 (38%) 6 (29%)
Continuing education 10 (20%) 6 (21%) 4 (19%)
Internship 9 (18%) 7 (24%) 2 (10%)
Family and/or Friends 7 (14%) 3 (10%) 4 (19%)
Private practice 7 (14%) 3 (10%) 4 (19%)
Do you know the clinical features of MIH?
99% 765 (88%) 428 (84%) 337 (94%)
Do you know if there are clinical criteria to diagnose MIH?
Yes, and I know how to implement them 37% 138 (42%) 70 (42%) 68 (42%) Yes, but I do not know how to implement them 37% 116 (32%) 60 (36%) 56 (35%)
In clinic, do you know if you can identify a patient with MIH?
Yes 98% 291 (34%) 146 (29%) 145 (41%)
Not sure 98% 458 (53%) 286 (57%) 172 (48%)
How confident do you feel when diagnosing MIH?
Very confident 39% 5 (2%) 1 (<1%) 4 (2%)
Confident 39% 49 (14%) 28 (16%) 21 (13%)
Slightly confident 39% 210 (62%) 106 (61%) 104 (63%)
Not confident at all 39% 76 (22%) 40 (22%) 36 (22%)
Do you have difficulty distinguishing MIH as a developmental defect of enamel that differs from other tooth conditions?
98% 679 (79%) 405 (79%) 274 (77%) Which ones? Dental fluorosis 98% 294 (34%) 166 (33%) 128 (36%) Enamel hypoplasia 98% 401 (47%) 235 (47%) 166 (47%) Amelogenesis imperfecta 98% 414 (48%) 250 (50%) 164 (46%) Dentinogenesis imperfecta 98% 127 (15%) 79 (16%) 48 (14%)
Are you aware of the prevalence of MIH in Germany?
98% 192 (22%) 97 (19%) 95 (27%)
Do you think it would be worthwhile investigating the prevalence in Germany?
98% 808 (94%) 472 (94%) 336 (93%)
How often do you notice these teeth in clinic?
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5ELHENNAWY EtAL.
3
|
RESULTS
Thirty-one universities were invited to join the study, of which 22 (from all parts of Germany; including the single private university), replied and contributed data (Figure 1). In total, 877 final-year dental students (59% 9th semester, 41% 10th semester) answered. Respondents were, on average, 26 years old (min. 21; max. 44), 628/877 (74%) were females and 226/887 (26%) were males.
The majority of dental students (97%) had already heard of MIH and most received their information from lectures (86%) (Table 1). Most students were familiar with the clin-ical features of MIH (88%), however, only 138 (42%) knew how to implement them. Moreover, one-third (33%) of the students reported clinical ability to identify MIH (Table 1); 54 (16%) reported confidence in diagnosing MIH and 79% reported difficulties distinguishing MIH from other develop-mental defects, especially amelogenesis imperfecta or enamel
hypoplasia. In total, 192 (22%) of the students were aware of the prevalence of MIH in Germany and most of the students (808; 92%) thought it would be worthwhile investigating this in more detail (Table 1). A total of 296 (90%) students had observed MIH in fewer than 10% of their patients, 30 (9%) reported to have observed MIH in 10%-25% of their patients and four (1%) in more than 25% of their patients.
The most common defects experienced by the students were yellow/brown demarcated lesions, followed by white de-marcated lesions and post-eruptive enamel breakdown. Few students (65; 19%) had encountered hypomineralized lesions in permanent teeth other than FPMs; mainly in premolars (Table 1). Approximately two-thirds (62%) of the students claimed that they had never seen demarcated hypomineral-ized lesions in the second primary molars (Table 1).
Regarding the aetiology of MIH, different views were expressed. Most students (67%) implicated genetic com-ponents, approximately one-half believed that antibiotics/
Question Total response rate
Percentage distribution of positive answers All students 9th Semester 10th Semester
Weekly basis 38% 13 (4%) 8 (5%) 5 (3%)
Monthly basis 38% 54 (16%) 24 (14%) 30 (19%)
Yearly basis 38% 262 (80%) 139 (81%) 123 (78%)
Approximately what proportion of patients do you observe these teeth in?
<10% 38% 296 (90%) 157 (90%) 139 (88%)
10%-25% 38% 30 (9%) 13 (8%) 17 (11%)
>25% 38% 4 (1%) 3 (2%) 1 (1%)
Which of the following features do you most frequently notice regarding severity of the defect?
White demarcation 38% 75 (23%) 35 (20%) 40 (25%)
Yellow/brown demarcation 38% 220 (66%) 120 (70%) 100 (62%)
Post-eruptive enamel breakdown 38% 37 (11%) 17 (10%) 20 (13%)
In clinic, have you encountered demarcated hypomineralized defects in permanent teeth other than the first permanent molars and incisors?
38% 63 (19%) 32 (19%) 32 (19%)
Name the tooth/teeth
Canines 6 (18%) 3 (14%) 3 (23%)
Premolars 22 (65%) 13 (62%) 9 (69%)
Second permanent molars 4 (12%) 4 (19%)
-Primary molars 2 (6%) 1 (5%) 1 (8%)
How frequently do you notice demarcated hypomineralized lesions in the second primary molar tooth in comparison to the first permanent molar tooth?
More frequently 38% 11 (3%) 6 (4%) 5 (3%)
Less frequently 38% 91 (27%) 49 (29%) 42 (26%)
The same as for the first permanent molar 38% 23 (7%) 13 (8%) 10 (6%)
Never seen it 38% 207 (62%) 99 (59%) 108 (66%)
Notes: Significant differences between groups (P < .05) are indicated in bold.
TABLE 2 Knowledge, attitudes, and beliefs on aetiology, management and education need of students towards MIH
Question Total response rate (%)
Percentage distribution of positive answers All students 9th Semester 10th Semester Which factor(s) do you think are involved in the aetiology of MIH?
Genetic factors 94 549 (67%) 335 (70%) 214 (63%)
Chronic medical condition(s) that affect the mother during
pregnancy 94 394 (48%) 223 (47%) 171 (50%)
Chronic medical condition(s) that affect the involved child 94 214 (26%) 125 (26%) 89 (26%) Antibiotics/medications taken by the mother during
pregnancy 94 466 (57%) 258 (54%) 208 (61%)
Antibiotics/medications taken by the involved child 94 256 (31%) 148 (31%) 108 (32%)
Environmental contaminants 94 391 (48%) 215 (45%) 176 (52%)
Acute medical condition(s) that affect the mother during
pregnancy 94 206 (25%) 112 (23%) 94 (28%)
Acute medical condition(s) that affect the involved child 94 137 (17%) 84 (18%) 53 (16%)
Fluoride exposure 94’ 77 (9%) 43 (9%) 34 (10%)
None 94 14 (2%) 8 (2%) 6 (1%)
Others 7
Aetiology not clear 38 (67%) 14 (61%) 24 (71%)
Bisphenol A 13 (23%) 6 (26%) 7 (21%)
Dioxins 3 (5%) 3 (13%) 0
Multifactorial diseases 3 (5%) 0 3 (9%)
Which material do you use MOST in treating MIH molars?
Amalgam 36 5 (2%) 3 (2%) 2 (1%)
Composite resin 36 192 (60%) 81 (51%) 111 (70%)
Flowable composite resin 36 73 (32%) 30 (19%) 43 (27%)
Glass Ionomer Cement 36 85 (27%) 43 (27%) 42 (27%)
Compomer 36 76 (24%) 34 (21%) 42 (27%)
Resin Modified Glass Ionomer Cement 36 118 (37%) 57 (36%) 61 (39%)
Preformed crowns 36 146 (46%) 84 (53%) 62 (39%)
Other 1
Ceramic crowns 6 (86%) 3 (100%) 3 (75%)
Gold crowns 1 (14%) - 1 (25%)
Which factors influence your choice of restorative material?
Adhesion 39 250 (74%) 125 (71%) 125 (76%) Aesthetics 39 146 (43%) 74 (42%) 72 (44%) Patient/parent preference 39 97 (29%) 50 (29%) 47 (29%) Durability 39 226 (67%) 113 (64%) 113 (69%) Remineralization potential 39 95 (28%) 51 (29%) 44 (27%) Sensitivity 39 146 (43%) 65 (37%) 81 (49%) Personal experience 39 70 (21%) 39 (22%) 31 (19%) Research findings 39 108 (32%) 71 (41%) 37 (23%)
Do you think MIH is a clinical problem?
38 323 (96%) 163 (96%) 160 (96%)
If yes, what do you experience problems with?
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7ELHENNAWY EtAL.
medications taken during pregnancy (57%), chronic medi-cal conditions (48%) that affected the mother during preg-nancy, or environmental contaminants (48%) were involved (Table 2).
Adhesion (74%) and durability (67%) were relevant fac-tors when deciding which restorative material to use in MIH. Aesthetics (43%) and sensitivity (43%) also had a relevant in-fluence, as had research findings (32%), patient/parent prefer-ence (29%) and remineralization effects of the material (28%). The preferred treatment options were direct resin composite (60%) and preformed metal crowns (PMCs) (46%) (Table 2).
Nearly all students (96%) acknowledged MIH as a clini-cal problem, mainly as the long-term success of restorations (60%) and diagnosis were challenging. Achieving patient comfort and aesthetics were considered relevant by 35% and 30% of students, respectively. Approximately one quarter of the respondents noted clinical difficulties in providing ade-quate restorations and determining the restorative margins for the restorations (Table 2). Nearly all students expressed their wish for more clinical training on MIH, especially diagnosis (92%), treatment (91%), and aetiology (60%).
Students in their 10th semester were significantly more familiar with MIH (P = .008), knew the clinical features of MIH significantly better (P = .0001), were significantly more aware of the prevalence of MIH (P = .011) and could diag-nose MIH better (P = .002) than those from 9th semester.
4
|
DISCUSSION
With MIH increasingly being in the focus of national media and dentists being faced with questions about this conditions by their patients, there is great need to assess on what knowl-edge base and according to what attitudes and beliefs deci-sions towards MIH are made by dentists. A range of studies assessing this aspect worldwide are available.22,26,28The
foundation for this knowledge, these attitudes and beliefs are mainly laid during dental education. A sound undergraduate education on this matter and solid competence to assess and manage MIH are required if this prevalent condition is to be dealt with adequately in daily clinical routine. This study as-sessed, for the first time in a nationwide approach, German dental students’ knowledge, attitudes, and beliefs towards MIH. Such studies are supposed to identify educational ac-complishments, but also to shed light on knowledge gaps that need to be addressed.
Almost all participants had heard about the presence of MIH teeth during their studies, which is consistent with the results of previous studies.22,26,28.
More than two-thirds of the respondents were not aware or did not respond to the question regarding the prevalence of MIH in Germany. This is similar to findings of a previ-ous European study where the prevalence data was known by only 23% of the respondents.20-23
Question Total response rate (%)
Percentage distribution of positive answers All students 9th Semester 10th Semester
Diagnosis 38 150 (44%) 73 (42%) 77 (45%)
Aesthetics 38 102 (30%) 52 (31%) 50 (30%)
Achieving adequate local anaesthesia 38 53 (16%) 22 (13%) 31 (19%)
Determining the restorative margins of affected enamel 38 82 (24%) 41 (25%) 41 (24%)
Providing adequate restorations 38 92 (27%) 42 (25%) 50 (30%)
Long-term success of restorations 38 206 (60%) 112 (64%) 94 (55%)
Achieving patient comfort (for function, oral hygiene) 38 120 (35%) 64 (37%) 56 (33%)
Would you suggest including clinical training regarding MIH in your dental course?
97 802 (91%) 466 (91%) 336 (93%) Diagnosis 97 787 (92%) 456 (93%) 331 (92%) Aetiology 97 509 (60%) 296 (60%) 213 (59%) Treatment 98 781 (91%) 451 (91%) 330 (91%) Other 2 Parents' education 2 (22%) 2 (25%) 2 (20%) Prevention 2 (11%) 1 (13%) 1 (10%) Prognosis 2 (11%) 1 (13%) 1 (10%) Differential diagnoses 7 (40%) 4 (50%) 3 (30%) Behavioural management 3 (17%) - 3 (30%) TABLE 2 (Continued)
However, the importance of MIH for dental students was highlighted since the vast majority confirmed that investigat-ing the prevalence would be worthwhile. The overwhelminvestigat-ing majority of respondents believed that they clinically notice MIH yearly, which may be one of the reasons why many students did not anticipate the actual prevalence of MIH in Germany. Moreover, it does not reflect the increasing prev-alence reported.3 It should be of concern for all educational
personnel to ensure that students see and deal with MIH patients during their undergraduate education. As reported previously,23 [29] yellow/brown demarcated opacities were
perceived by the participants as the most frequent enamel de-fect observed.
Approximately 20% of the students reported difficulties in differential diagnosis of MIH-affected teeth. Besides, more than 80% of the respondents were uncertain if they could clinically identify MIH. This explains the very high proportion of dental students requesting further theoreti-cal and clinitheoreti-cal training regarding the diagnosis of MIH in their courses; in addition to training for MIH aetiology and management. Resin composite followed by preformed metal crowns were the preferred materials used in the treatment of MIH-affected teeth, consistent with previous studies,23,24 however, Crombie et al25 reported that GIC
was the preferred material, especially amongst oral health therapists; however, this preference had reduced somewhat 10 years later.23,24
The results from this study revealed the shortage of clin-ical exposure to MIH in the German undergraduate curricu-lum. Despite the worldwide growing interest and awareness of MIH, it is not yet integrated in-depth in dental curricula. However, in some aspects, the students’ responses in regards to the clinical presentation indicate a good knowledge of MIH. Given that the main students’ information source on MIH was their lectures, it is possible that an acceptable the-oretical base is implemented in dental curricula in Germany, however, the clinical exposure is inadequate. The lack of thorough clinical training and exposure to MIH in undergrad-uate training will lead to a future generation of dentists facing great challenges providing the best possible evidence-based treatment of MIH-affected patients.
4.1
|
Strengths and limitations of the study
This study has a range of strengths and limitations. Firstly, our study built on an existing and validated question-naire22,26 and was validated again for the purpose of our
assessment. We hence ensured robustness and comparabil-ity with other studies. Secondly, a nationwide design was chosen, and given the achieved sample size and response of dental schools, the yielded sample will have produced robust information. Notably, though, we did not perform
a non-responder analysis, since it was not possible due to the anonymous response. It is conceivable that the dental schools where our questionnaire was not distributed either have a very intensive curriculum on MIH or do not teach it in much detail at all; hence, selection bias cannot be ex-cluded. Thirdly, and as a limitation of any survey study, students putatively provide ‘desired’ responses given them being aware that their answers were being evaluated in a study. The anonymity of respondents should have limited this source of bias. Future studies with a qualitative or clin-ical observational design should strive to confirm our find-ings, though. Fourthly, the findings of this study are not generalizable beyond the sampling context; knowledge, attitudes, and beliefs of students in other countries may differ. Lastly, it would be relevant to see how students’ knowledge and beliefs correlate with that of dentists, that is, if the observed gaps are somewhat filled during post-graduation education or persist long term. If the latter was the case, there seems to be great need for systematically improving German teaching of MIH.
5
|
CONCLUSIONS
Based on a nationwide sample, German dental students are aware of MIH and had some knowledge of it. Notably, their reported clinical competence and confidence was limited, and it remains unclear if students are truly fit to self-reliantly manage MIH in their daily post-graduation practice. Our findings call for the implementation of more in-depth and practical training on MIH in curricular and post-graduation education.
ACKNOWLEDGMENTS
The authors would like to thank and acknowledge the contribution of PD Dr A. Rahman (Hannover), PD Dr M. Wicht (Köln), Prof. Dr A. J. Momeni (Marburg), Prof. Dr P. Scheutzel (Münster), Prof. Dr G. Krastl (Würzburg), Prof. Dr C. Hirsch (Leipzig), Dr P. Singh-Hüsgen (Düsseldorf), Dr A. Geiken (Kiel), Prof. Dr S. Rüttermann (Frankfurt), Prof. Dr A. Wiegand (Göttingen), Prof. Dr D. Wolff (Tübingen), Prof. Dr S. Rupf and Prof. Dr M. Hannig (Saarland), Prof. Dr S. Zimmer (Witten), Prof. Dr A. Wichelhaus (München), Prof. Dr H. Wehrbein and Dr E. Scheer (Mainz), Prof. Dr F. Stahl (Rostock), Prof. Dr Hellwig and Dr P. Fischer (Freiburg), Prof. Dr Dr S. Jepsen (Bonn) and Prof. Dr Schaller (Halle), Prof. Dr Dr P. Proff (Regensburg). Open access funding enabled and organized by Projekt DEAL.
CONFLICT OF INTEREST
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9ELHENNAWY EtAL.
AUTHORS’ CONTRIBUTIONS
The study was conceived by KE, FS, PG JB. KE, DM, KB, CS, and JK planned the analysis. MA, ZH, and KE collected the data. MA, FS, JK, and KE performed the analysis. KE, MA, ZH, and FS wrote the manuscript. All authors read and approved the manuscript.
ORCID
Karim Elhennawy https://orcid.
org/0000-0002-5216-9452
Katrin Bekes https://orcid.org/0000-0002-5249-0123
David John Manton https://orcid.
org/0000-0002-4570-0620
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How to cite this article: Elhennawy K, Anang M,
Splieth CH, et al. Knowledge, attitudes, and beliefs regarding molar incisor hypomineralization (MIH) amongst German dental students. Int J Paediatr Dent. 2020;00:1–10. https://doi.org/10.1111/ipd.12715
